98-525 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
September 23 98
Elate 19
)o G -
This is to certify that work requested to be done as rhown by Permit No. 98525
has been completed.
MOBILE HOME
This structure may be occupied as a
LOT 126 HOMESTEAD VILLAGE
Location
Owner COREY , JASON & CHRISTINA
TAX MAP NO * 93 . - 2 - 1 1 . 1 By Order Town Board
TOWN OF QUEEN BURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
VALUE $ 10000TQWN OF QUEENSBURY ,,, 98s25
TAX MAP NO a 93 . - 2 - 11 . 1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to COREY , JASON St CHRI STINA
OWNER of property located at LOT 126 HOMESTEAD VILLAGE Street, Road or Ave.
in the Town of Oueensbury, 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 Queensbwry Building and Zoning Ordinance.
t. 0 WNE R'S Address is
LOT 126 HOMESTEAD VILLAGE
QUEENSBURY , MY 12804 12804
2. CONTRACTOR or BLH LIXA% Name
GLENS FALLS MOBILE HOME INC .
3_ c`J13�GRATQR_orT�ButA RD Addr.ss
G39ANSAEVRAOORT , NY
4. ARCHITECT'S Name
COMMONWEALTH ELECTRICAL AGENCY
S. A RM T JOR Add6V
HAGUE , NY 12836
B. TYPE of Construction — (Pteeae Indicate by XI MOBILE HOME
i I wood Frama ( f Masonry 4 1 Swel l I
7 . PLANS and Specifications
701aX 14r MOBILE HOME AS PER. PLOT PLAN SPECIFICATIONS
B. Proposed Use
MOBILE HOME
35 August 28 2000
$ PERMIT FEE PAID - THIS PERMIT EXPIRES , 19
(If a longer period Is requhed an application for an extension muat be made to the Build" and Zoning inspector of the
town of Queeetdwry before the expiration data.)
28 August 1998
Dated at the Town of Queeni;Wry this Day of 18
..'
SfGNED BY for the Town of Queensbury
euildhigi and OR lngpecw
r■ ram^-�,+, � �/� �] fr r■ r* I ] I � /T Syr '
r,14 �'lJ Y Y 1 �f Oil i 4/ ,l fr,[ �. NS !3 'ti.J' R A u
REVIEWED BY :
FEE PAID : }
Y
PERMIT NO .
APPLICATION FOR PERMIT
MOBILE HOME our MODULAR
A BUILDING PERMIT MUST DE OBTAINED BEFORE PLACEMENT OF MOBILE DOME .
NO INSPECTIONS WILL BE MADE UNTIL A VALID BUILDING PERMIT IIAS BEEN ISSUED .
. . a . . . . .
Tire owner of this property is : Pvi
P . O . Address : . Phone Number � �
Property Location Z Tax Mal) No . / /
NAME OF APPLICANT : 4rf
Address of Applicant :
All applicants spaces on this application MUST be completed and the
signature of tine applicant MUST appear on the reverse~ side of this application .
PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES :
MOBILE 14014E INFORMATION
APPROX IMA I E VALUE OF HOME *
New Barre Yes ZONING INFORMATION :
Replacement Home e, Na Size of Property : ft x ft
Size of mobile
bome �7&_ftx_Lqft ExisLir►y Buildings :
Singlewide V Doublewide
No . of rooms Proposed building-distance from property line :
( exclude baths ) Front Yard ft Rear Yard ft .
No . bedrooms 2ho Side Yards ft and ft ,
No . of bathrooms Primary
Information :
Primary dwelling : Yes No
Fireplace -- Woodsto+ve ~` "" Accessory Duildirrg ( 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 —
Other
Depth below grade ft
Foundation- Footing size x
Proposed date of placement :
Nall material
Wall thickness It
sleight Water Supply : Well Municipal
Total depth below grade ft . Septic permit required ?
Grade to home floor. level ft .
FIIRTIIER INFORMATION REQUESTED ON TIIE REVERSE SIDE OF 1IIIS SKEET
NAME OF INSTALLER/MOBILE HOME DEALER : ;2 XJ2/ -
ADDRESS/PIIONE NIIMBER
STATE OF NEW YORK DIVISION OF IIOUS 1 NG AND COMMIIN I TY RENEWAL
INSIGNIA OF APPROVAL OF TIIE STATE RD I LD I NG CODE
1 . Insignia serial number dr:� T3 4L'__
2 . 'Name of Manufacturer
iv
3 . Plan Approval Numtler
q , Model or Component Iles i gna ti on (���3 � !• � � *-�- � ���
5 . Date of Ma nufacCure
All tine above information is to the found on it Plato or sticker which
should he affixed, to the Motile liorue . Complete all« ve with that Information ,
Town of Qtreenshtlry Stage of New York
Comity of Warren
AFFIDAVIT
I swear that to the nest of illy knowledge and bel lef the statements contained
in this application , together with the Flans 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 Iltl [ LOING CODE , the ZONING
ORDINANCE . and all other lags pertainHig to tihe proposed work shall he complied
wi th , whet lie r spec If Ied or not , and that silch work Is e` iiLlhorI zed by the owner .
S i J n a t r l r e
I?wirr e . hwrler ' s gen architect .
rah r a c,
SPECIAL CONDITIONS OF PERMii' :
By
Coile�Tnforcement 0 f f i cer
DECLAR✓ITT04N.o Please sign below gfler yoee have carefildly read lie stateueer'rt.
To the hest of my knowledge tire; siale:ments corltained it] this application !ob:: ' with t1hm plans
and specifications submitted, the 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
oliser laws pertaining to the proposed work shall be complied with , whether specified or noted, and
that such work is authorized by the owner. l �trrther, it is trndersttxxl thal 1/we shalt submit prior to a
Certificate of Occupancy or Certificate of Compliance being issuc:rl, an AS BUILT PLOT PLAN by
a licensed surveyor, drawn to sc4afe, showing actual 1tw.ttioer of project on premises.
Signature:
(owner, owner's agenl, architect , contractor)
�G-r10
SP Mp,�3iJV,pR
saw
Md Tin of aueengbUrV
Building & Code Entarcernenl
742 ryy N��a
au peg 7s'- Q, /
�m
DEPAR
JES'r P -VED.
DATE INSP C'nON Py �f
L,ccxTl0 lT #
Dp'L'E,� Md
YES 140
rn . ' �-
r a'as'ur ,ruf.
watery une8 (
shut.o€f
3.
sewer ujw Support off gf - f
A. ting crossover C
5 .3wd aside ...
g. dryer " vesntilad . .. ... .. . .. .. •• is
7 . relief valve PiPi g
8 WgLW
hes, Steps• La� P . .
g, 'deck' Potc e water �g
CI O• £use fire per," ,. .. , ..
-�`
door closets
1ingu P urnlbu�g latiars (K
- �
14 £ueritc►rs .. . .
-- _-
15. srnake . . . .
l61 fioai
variau ciecmcai . ..
17 .
required • -
y$. data Plater seal aka .. . .
19 mile serial, #
Model #
��,�,cturer
Daw of Mar►ufact yTaS _•_-__. i3Cl
l3E CIO _"____. �I
pl�Ay "CO lS /!\I ( o U ��1 1 "
�
's
M�1 M pplJ�-A"
p131L'E �` sbuvy
.T�n cat Queen
Bu#1d#ng & Code Entorcem�
142 Bay Road
Queensbu i 4'Y 280
(518) it
?-
DA'l"B JNSPeeC-nON REO'L S
SCS[V�
` z. •. y
lip
NAMR'
LOcxInON: ? PF'TtMIT 1
140
onxxs Kos$ ----- VpAMING
cKv L --
No
NAP► 'YES ,�
} Pier mg
1. er rranuu uf. .. .
Z ar+Chorlin shut ong Pet
3• grater sum 4 4. awide) off off 8rd•
5. t�,atns esrted y:ye . ... .. . .. . ... .....
6. dryer v . .. . .. .. ... .. . .. ...
7. skirtmg w relse f valve piP}Ag outside
S. hot ` hes, steps. rai'iuz8 " ' -'
9. d� e� .Hater �� ... .•. . .
1p. fire pofing . . .. .
11.
12. door Closers . ... ... . .. ., . .. ...
13 plum" f"�aaU ti�, (if +MP�PI.).. ..,.
hss
14. f�atrian • � ----
15. smO det a�
lb. final electri . .. • •' ----'
_ -
17 . yar}y�nCe mquar�d ... ... -
1B. data Plate Okay �-
14* p ale f1UD seal olcaY .. .. . .. ... .. .• OL
470 3
Model #
M u tuner N'`( r ( F. kvp
Date of Mu{acturer
NO
OYWY r0 issUjs Cf0
comments:
{
,ti
1=11VAL 1p4MF U1=V1C r4 W,iWpatrMs" V
MC301LE r MoE3ULjk1R,
Town of Queensbury
Building & {Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 76143256
ARRjvEkjLq4DDEPAR7k%j�,;� �i
DATE INSPECTION PEQUEST RECEIVED:
NAME:
LOCATION:
DATE: �� � � - [ � PERMIT !/
MOISME HOME
HOME
pDCnrldGS FrOUNDA'r'ION BAC7gari a. FRAMINQ
NIA Y'Es NO
14 foundation support, pier spacing
jper rnanuf.. . .. .. .. .. ... .. .. . . .. . ». . —. --
2, anchoring per manu€. . ,» .. .. .. . .. .. — --
3. water line shut,off , .. .. .
4. sewer line support {9 4 feet .
5. heating crossover (dbl de off grd,
6, dryer vented outside .. .. ..
7. skirting ventilated . .. . .• . » - —
S, hot water relief valve iping ide — - -
9, deck, pouches, s • railing -
11. garage fire Ping .. .. .. . . . .. .. .I .. . --
12, door closers
13, plumbing fixture .. . .. .. .. . . .. . --
14, fourrdatiOn insulation (if app1.).. .» ..
15. smoke detectors . ..... .. .. .. . . . .. .. .. ..
16. final electrical . .. .. . ., ». .. .. .. . . . . . .. .
17. variance required ... .. ..
18. data plate okay .. ... . . .. ..
19. mobile HUD seal okay • .*�. .. .
C, ik^ 't7t�'�i�.5
M.&I # Serial # CSt 15 �3 1�
_ k�L�` I-7�� 5�r� "` C� y
Manufacturer co qp-Cr
Date of Manufacturer
OKAY TO M2i==ED YES No
Comments:
R � 5A
NOTICE FILE COPY
A%cHORING Of MOBILE HOME UG 'ja
FRAME IS REQUIRED PER
MANUFACTURERS SPECIFICASIONS
C\ X_Lc,71
TOWN OF QUEENSBIIRY B TIDING DEPARTMENTI
Based on our limited 1 xarnina#ion,
compliance with our mments shall <�
not be construed as it ficating the
plans and specificatio s are in full
compliance with the a e.
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