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98-593 TOWN OF QUE)ENSBURY WARREN COUNTY; NEW YORK October 15 9 Dace 19 98593 This is to certify that work requested to be done as shown by Permit No. a has been completed. MOBILE HOME This structure may be occu_ppied as a LOT 58 HOMESTEAD VILLAGE Location SHERMAN , CLYDE & THELMA Owner TAX MAP NO , 93 , - 2 - 1 1 a 1 By Order Town Board / TOWN OF QUEENSOURY Director of Bldg. & Code Enforcement BUILDING PERMIT VALUE $ 65000TOW N OF QUEEN5BURY TAX MAP NO . 93 . - 2 - 11 . 1 WARREN COUNTY. NEW YORK PERMISSION is hereby granted to SHERMAN CLYDE & OWNER of property located at LOT 58 HOMESTEAD VILLA Street. Road or Ave. in the Town of Queein a To Construct or place a MOBILE HOME^ at the above location �n accordance to application together with plot plans and other information hereto filed a nd approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. t. OWNERS Address is LOT 58 HOMESTEAD VILLAGE QUEENSBURYr NY 12804 12804 2. CONTRACTOR or BUILDER'S Nano SHO MOBILE HOME BROKERS 3. CONX rUTEI L5 R S Address SARATOGA SPRINGS , NY 12866 4. ARCHITECTS Nome S. ARCHITECTS Address 6. TYPE of Construction — #Please indicate by K) MOBILE HOME ( f Wood Frame I I Masonry t I Stool I I 7. PLANS and SPecifimtiord 2 $ rNX 700 MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS r posed UseOBILE HOME '35 September 22 2000 S PERMIT FEE PAID - THIS PERMIT EXPIRES 19 (it a longer period is racluired an application for an extargign must Ise mad* to the Building and Zoning inspector of the town of pu*ensbury h*#ore the *xpirstion dals.l 19 9$ 22 September Dated at the Town of Qiueensbury this Day of 19 r� for the Town of aueensbury SIGNED BY f3ulldirgatW Zon rq lratpector` ri 7 0 WN CAI' Q UEF WS B UR Y REVIEWED BY : FEE r A I D : PERMIT N0 . _ ' APPLICATION FOR PERMIT MOBILE 1 MOME 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 : 7 llL� ( C, . P . O . Address : A — 161 , .,.Iv Phone Number Property Lacation. /i 7'`�j �r I IAIq�,S1. L7k* ilk° 't75 � c1 Tax Map No . / f /�/. NAME OF APPLICANT : +�..:• { JF / ) : ' 3`t' lam , F Address of Applicant : 16�- �- w�+'� - 3%5.� 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 • SEA ) )' g MOBILE IIOME INFORMAT I0N APPROXIMATE VALUE OF HOME : : New ilome es No ZONING INFORMATION : Replacement liome Ye No Size of Property : ft x _ , ft Size of mobile homeg ftxft Existing Buildings : ,Gb/[J SingTewide Doublewide No . of rooms ( exclude baths ) Proposed building-distance from property Tine : Front Yard ft Rear Yard ft . No . bedrooms "+ Side Yards _��ft and ft . No , of bathrooms Primary Informatiorii Primary dwelling : Yes No Fireplace k` 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 Z Size Storage building eft x /-S'ft Other Depth below grade` 1i {t Foundation- Footing size04 it x Proposed date of pla em nt : Wall material ��1,� c5k &' v� Q� c c�p Wall thickness." lieight to Water Supply : Well Municipal Total depth below grade M6 ft . Septic permit required ? AQ Grade to home floor. leveTA41 -ft . FURTIIER INFORMATION REQUESTED ON THE REVERSE SIDE OF T11IS SHEET NAME OF INSTALLER/MOBILE HOME DEALER : 1►'r,at3a1F' 1'�Orrr a FJI771C�+'S ADDRESSJPlIONE NUMBER 3048 RaLaie S0 c-%rafaao i�F+r+.+Qs ,� Al y 12866 ff STATE OF NEW YORK DIVISION OF HOUSING AND COMMUNITY RENEWAL INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE 1 . Insignia serial number 9A Fz GJ22A8 44$ 124 - SKI 2 . Name of Manufacturer F1 tttwood 3 . Plan Approval Number 4 . Model or Component Designation ,, tor►�el< 4'4043 5 . Hate of Manufacture All the above information is to be found on a plate or sticker which should be affixed to the Mobile Ilonle . Complete above with that information . Town of Q►►eensbury 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 k)e,. 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 specifier] or not , and that such work is authorized by the owner . Signature Owner , owner ' s agent , architect , contractor SPECIAL CONDITIONS OF PERMIT * By Code Enforcement Officer DECZAARATI©N.- Please sign helots after you have carefully read the statentent. 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 BULL T PLOT PLAN by a licensed surveyor; drawn to scale, showing actual location of project on premises. Signature: (owner, owner's agent, architect, contractor) TOWN OF QUEE BURY 742 Bay Rd., Queenssbury , NY 12804 APPLICATION FOR SOLID FUEL BURNING APPLIANCES AND C MNEYS Date ( le , 19 77 Permit No. _ ; APPLICATION IS HEREBY MADE to the Building Dept. for the issuance of a Building and Use Permit 3 pursuant to the New York State Fire Prevention and Building Code. The applicant or owner agrees to comply with all applicable laws, ordinances, regulations, and all conditions that are part of these requirements and also will allow all inspectors to enter premises to perform required inspections. Please fill out additional form if more than one appliance andlar chimney. Applicant el, ..�.r�i'"f '.2 r•f .a *44Z APPLIANCE (check appropriate boxes) Address S40+9" or s/ �#�/� �f ��'!f it 0 STOVE: o Wood r3 Coal o Pellet o Gas —� O FIREPLACE INSERT ,as.r .t , t Zip .� o' S� — [ii�"FI REPLACE, MwW oFACTd R o Gas T: PhoneSf ? v 0 FIREPLACE, MASONRY: C3 Wood r3 Gas Owner /�r.,✓�c S' '`� ,K .�r.a.�✓ ❑ FURNACE: p Wood p Gas p Oil Address IF NON-MASONRY APPLIANCE: Manufacturer: Zip Model: M 'i�' Phone CHIMNEY (check appropriate boxes) * EXACT ADDRESS of propose n ruction O MASONRY: Block Blrick Q Stone ` t^ FLUE: Q Tile 000 teel SiZe: inches CONSTRUCTION / INSTALLATION MUSS" FACTORY-BUILT: CONFORM TO NYS FIRE PREVENTION & Manufacturer: Number:. BUILDING CODE. CONSULT AVAILABLE Listed By : _ TOWN OF +QUEENSBURY HANDOUTS © C7oubfe Wall o Triple Waft REGARDING REQUIRED INSPECTIONS. c3 Insulated LinerDirect Venting Cashier' s Department Town of +Queensbury, New York Amount Collected Amount Refunded Dept; fire Marshal Code Number Title 2 A 173 3389 (190 ) Public Safety A 233 2655 (230) Minor Sales Fee Collected From or Refunded to: Address : Dated : Town Clerk or Depu Pink & Goldenrod: Cashier's Dept, Applica t Green: Fire Marshal Yellow: Bldg. Dept. I TOWN OF QUEENSBURY FIRE MARSHAL QUEENSBURY. NY 12804 (518) 76 1 -8205 l FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED NAME _ I LOCATION DATE PERMIT # "r APPROVED NIA YES NO EXITS AISLE WIDTHS EXIT 51GNS EMERGENCY LIG TIrN FIRE EXTINGUISHER AUTO. EXTINGUISHI HOOD INSTALLATIO AUTO. SPRINKLER SY ALARM SYSTEM INTERIOR FINISHES STORAGE: CLEARANCE TO SPIINKL RS CLEARANCE TO HTING NITS REQUIRED SIGNAGE i CHIMNEY WOODSTOVE FIREPLACE - MAS NRY FIREPLACE - FAC ORY BUILT REMARKS: OK THIS 'DATE INSPSLIPRUB NSPE O I Town of +Queen4urY Building & Code Enforcement 742 Bay Road Ciueensbury, NY 12804 (518) 761-8256 _r' r ARRIVE' �t DEPART: �i% INS DATE INSPECTION REQIJ CESV ps NAME. LOCATION: DATE: PEE T # �% i b[i3HILE HOUR MODW HOME F 0"NGS FCILTNISA ON � BA FRAMING NIA YES NO 1. foundation 9Mu4PYP0rt1 p1espactng per manuf. ..» ...4 .. .. 2. anchoring per mauouf. .. .. .. .. .. . . .. �- 3• water line shut. off . ._ .. 4. sewer Brae support CW 4 feet 5. heating crossover (dblewide) off gird• 6, dryer vented outside .. .. .. . ». .. -- 7. skirting ventilated -- $o hurt water relief valve piping ide -- 9, deck, patches, steps. railing -- 10. fusrlacelhot water operating .. .. .. .. -- -- 11. garage fire proofing .. . .. .» — -- -- 12. door closers . . .. .. .. . .. .. .. . . .. .. .. . 13, plumbing fixture .. .. .. ... . .. .. . .. .. .. M foundation insulation (if 15* smoke detectors .. .... 16* final electrical -- 17. variance required . .. . ,I .. .. .. . . . .. . . -- 1$* data plate okay .. .. .. .. » — -- 19. mobile HUD seal y , .. .. . — _— Model # Serial # manufacturer Date of Manufac er OKAY TO ISSUE CIO YES NO Comments: C'C> i T�C3�N ARSH P+►- IF IFIRE •� 12$�}b {�VEENg6UR� � � 5 (518) 761 -$ Rl 'FIRE �F'R'1-IA►- 1N'PECTI©'�'1 VpIL y:C� t SPecTIC�N REGENEa REQUEST �~� ''1 Tta L©cAN �c> tot aATE PERMIT # NpApROEEaNC7S EXITS AISLE la EMERGEOCc LI�,HTING F1RE eXTINGUls1-IERS sysTEM AlSTQ EKTINGUtS --�� k-1C>'ba INSTALI•ATIC) �M .�.�----�"- Au-[0. SPRINKLEF SY ALARM S'(STE.M l4 iTrtRlc�I FINISMES sjojzP.GE' TC7 5PRlNKLERs cLEARP N GETO HEAT1h1G UNITS QLEARArA A�,E RE.C�1,SIi2Ea paSXC.a'`d'E �-�---�- NN© FIREPLACE - M CTpRY pyISIL GK Q IS aATE FIREPLACE - FA REMp,RICS: 10sip sr+sQSG�g.pua �e f law 000 'y, asp lop s � �e`rt1► � l S• met v ve �-- WOW 9 • e # N.s• g p4� ►N'�p���Ol.i'1„p.R QUeWtsbxWTV g(►1 t En1oKG tau+�&CQ�B Y fkoad t �g18'1 761 8� , ,p, PAJ�T. . . t mAem. I _ Ar"O - p �C►BILB Pp[1Z3S�E* OCR B� CI S 140 r� xt, ptex Servo$ �x pertnan r -- _ s'hol off �4 'fit �-- 03. O -_ Aself 8 }yes. steps' w 9• cxc 14 xatsn$ `f ire 4xo" - ": gaxa8e fire .. . .». 1014 ckaox fuck tics 4i€ aFR1.7.. .... 13• pl'a�' uoxt ix+s'nla - - LS, sxr ,}ceeral _- 19Num x+rd1le '1 � 5eival # �N pfabpYxex o€ M "fact""xex 'SO To }SSA CIO C.A. AI TH ELECTRICAL INSPECIT;ON Cf)MMC1N Terrace — MarXheinX, PA 17545 RpjJAL Ma1n Office 357 Elwyn ELECTRICAL APP MUNICIPAL CERTIFICATE f� 59232 Cut-in Card Nta. _. .. .. Panel Bxrard No. . . . . .. . . ... . . 4...- ._- Owner C L ./.p.. . of V Occupant4eq,.P. Q. . .. .. . .. � ... J` 2 �' . !L. . SnstuYYation Consisting o4 ............... ...-.. LiC, #----------. ._-. reviously t,.K� f�t'f r�""' of this certificate, and any Instailed BY . , ... . overned the issuance X} made iur The conditions foilowing R c ui rrXent and 'soslaitaiion �;onditicsn{ m`pr1 date • f"tn ur uitcrations, apptication shalt >x P issued is cancelled: ©nSY covers the eiectrnt q P isme. and if itx "This certificate additional equipment insp e Of makintt ections at any the Introduction of a Tivilete rtifirate . inspectior+. an shaiS have the p " „ lnspeetorc rat Xyis Corte y - . .. - . . ru4es are violated, sn ssh! have the right to seyoke this c+e P.A... 1.p.E.t. f 1f3SP@C'TO ptember fi.F. 'gate .......e!.57. ....eJ?./•-•9aS -.. .- NOTICE TdWN as Q of UEEN58URY B{1114114G DEPARTMENT_ Based on our limi#ed examination, L40M of MORU"K compliance with flux commers shah ERRME IS REQUIRES PER not n u fscatioas are�Iin HLE COPY f�IFJVCTI, ER$MICATI4NS i� yet 170 ' � v c'q ac 8t I SEP 1998 - YIN UP"" 13 01119XVA 'bn St'Ki16 w 6 C;OYAU ) �Ek M6 q ' 1 � ce �3 �r 49' SEP �g I �