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1985-700
1 CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Daft - 19 This is is to certify that work requested to be done as shown. by Permit No. has been completed. DM (!b" 11tj This structure may be occupied ' J1, as a ''"F 1F r 1- _, 1� ri vr�4� I T' 'f ✓ I.AW&CiOn li ' -'T Owner C' T C'.r r r• r�f " By Order Town Board 3`6WN OF QUEEN'S$URY f ` Building & Zoning Inspector G IRCATVE "IMST F" PNINV'"ff, GC ENS F^L LS. N Y 12501 is ir17sa-sasa -�- BUILDING PERMIT TOWN OF QUEENSBURY No. 85- 700 ' WARRENCOUNTY, NEW YORK PERMISSION is hereby granted to , George Ramoska OWNER of property located at Lot 28 Michael ' s Drive ( St . # 11 Street, Road or Ave. G7 in the Town of Queensbury, To Construct or place a One—Family Modular Dwelling 0 at the above location in accordance to application together with plot plans and other information hereto filed and u� approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. :rJ 1 . OWNER'S Address is O En x w 2. CONTRACTOR or BUILDER 'S Name Lamplighter Homes 3. CONTRACTOR or BUILDER'S Address 0 ct RD # 2 INS.) Fart Edward , New York poi 4. ARCHITECT'S Name i'1' H. {Z o M S. ARCHITECT'S Address to Cl W �• C 6. TYPE of Construction — (Please indicate by X) { ) Wood Frame ( ) Masonry { ] Steel ( ) 7_ PLANS and Specifications 26 ' x48 ' per plot plan , specifications and No- application submitted including sewage system . 8. Proposed use THE ATTACHMENT OF THE TWO PARTS MUST BE APPROVED BY A LICENSED PROFESSIONAL ENGINEER. One—Fam±ly Dwelling $ 5 . 00 C/O Paid ~+ $ 91 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES .Tune 1 19 86 (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the Q town of Queensbury before the expiration date.) Dated at the Town of Oueenshury this 2 5th pay of November 19 85 0) tzi SIGNED BY for the Town of Queensbury Building and Zoning Inspector lw- W- TOWN OF +QUEENSBURY (Space inside block to he lillt•d ist b% WARREN COUN1TY. NEW YORK Building lnslx•t•u>r) % ppli( alitoll No. Application for Qp l,(-'t�rIuir ls,tstul 14 BUILDING AND ZONING PERMIT 1>, `, III is Espir44 l THREE ( 3 ) Copies of a PLOT PLAN, Drawn to scale '� +� 'r'"" `l 1" showingt� the actual dimensions of the lot to be built upon, TMa. exact size, and location on the lot of the building to be erected or altered MUST BE SUB- MITTED WITH THIS APPLICATION, TOWN OF +QUEENSB1 RY Hare A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK ANSWER ALL OF THE FOLLOWING. NOV 19% The undersigned hereby applies for a permit to do the following work Ijej9 xI2IgI4I PA which will be done in accordance with the description. plans and specifi- ,� 1y Ys I�"t+ 1 Is cations, and such special conditions as may be indicated on the permit. J�r_Xrt'- � ► q/ The owner of this property is: +� - fy" . . . e dip. . . . . . . . . . ./r , .r. L�. r►.e. rs. . . .�f]-y�,. .? . +°� x : r+ ! .k`?S. �s. -e .. y - 7 fNA E) IP o. ADDRESS1 The person responsibia for supervision of the work insofar as the Building Goole and the Zoning Ordinance apply is; e s2"f"'.y . - . . . . . . L,�t s+ t ?1, .4 " Tt*.•c. . 499 �- ?ems w .fa .rr ct , . r iiAMEI !P o Acrosess) �! Name of Builder _G r�x+ t� I G f! T`t PC � 4 !'� . `a -t . . . . . . . . . Address J.Z-�. . . 2 . . � !4 7: Name of Plumber . . *r-r+'t• ' I r .t .l4/T.p. ex- . . /AIC?r't a. l'. . . , . . . . . . Address 1?. ' . 'L :2.-. . � Nameof Mason , Te u . . . . . . . . . . . . . . . . . . . . . . . Address MI5 ". a14a..+ s+ � ?¢ !•^ . . . ' s , •- . {s . . 1 .. . . . . . J`r Lot Number . . . 3 e . . . Unit . . . . . . . . . . . . Estimated value of proposed work S . . . 7l . . . . . . . " " . " . . . . . - . . . - r�f, � Name of Village . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '_, + Name of Street f'? I!*. a�i}t . f • • D . • r.( t". ' • . " . . . . Side of street: north 0, east 0 . south ❑ . west g4 Nearest Cross Street , F? .+''! "J . . , . "9! . ^ . 9 . . . . . . . . . . . . . . . . Distance from this !-Toss street . . . . . . Property is north ?L south ❑ , east 4M , west ❑ from Cross Street If on Corner, which corner, northeast 0 , northwest ❑ . southeast southwest (Designate by marking with an "K" in the correct space.) NATURE OF PROPOSED WORK OCCUPANCY Construction of a new building. Main Bding Two-family Addition to a building. -family dwelling uil © Alteration to a building. Two family dwelling -family apartment house � (] Demolition of a building- Store building . . . . -car attached garage L� Other: d . . . . . . . . . . . . . . . . . . " . Accessory Building One-car detached garage Other work. Describe: . . . . . . . . . . . . . . . . . . . . . . Two-car detached garage Private chicken house . . . . . Private storage building � Other: . . " . . . . . . . . . . . . . . " . . . - . . . . . . . . . - - . . . . . . . . - ZONING SPECIFICATIONS- Fill in for new building, or addition to existing building, or a change of occupancy. Indicate on the plot plan street names, the location and size of the property. the location, site and setbacks of pro- posed buildings, and the location of all existing buildings. NORTH Shaw proposed buildings) in dotted line and existing zu 60 huilding(s) in solid line. Size of property . , . /! y? _ ' . . . . . . ft. x . . . rr. z% , . . ft. � Size and use of existing buildingso if any . . . . . . . . . - !� t7. . . . . . . . . . . . . . . . . . . . . . . . . s Size of proposed building it. Height (from grade to ridge) . . . . . . . . . . . . . . . . . ft. a Front yard . . . . . . ..r'' .. 0 . . . . . I . . . . . . . . . . . . . . . . . . ft. I Side vards . . . . 7y�. . . . . . . . ft. and - . . /. C" . . . . . . . . ft. Rear yard . . . . . v? .1lc. . . . . . . . . . . . . . . . . . . . . . . . ft. souTN If on corner, setback from side street . . . . . . . . . . . . . . . ft. Note: AIt distances are net, as measured from street side line to nearest part of building. to v E R] 7-73—M lcont'd,y BUILDING SPECIFICATIONS., Kind of construction-- Wood frame, fire safe, etc_? . . . 4. • v W ill any second-hand lumber be used? . _ I f so, for what? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Material of foundation walls c-- Rt' :T, e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Thickness . . . . .FF". " Depth of foundation walls below grade . . . . , . . . . !r' . . . . . . , . . . . . . . . . - - . Continuous foundation ? cC•r...x . . . W ill there be a cellar? . . .5. , . . . . If so, material of cellar floor . . .(2- �. $ - r .� . . . . . . . . . . . . . .Type of roof: Sloped or flat? . .S l * . , cE . . . . . . . Material of roof . W P 4 .4 . -. _ x4 4 'P IVAw 1. r Size, wood studs - . - - . . . . . . o - . . . . . . . " x . . . . .fie. . . . . . . . . ", spacing - . . ✓ _fm ."ox., length . .. . '.fi.. .. . . . ft, Size, floor beams, 1st floor . . . . . . 4 . . . '" x . . - - r! may. . . . . . . "', spacing . . . . v;2 . . . . . . '"o_c_, span Size, floor beams, 2nd floor 11 x . . . . . . . . . spacing . . . . . . . . . . . . . '"o,c., span . . . . . . . . . . . . . - ft. Size, ceiling beams . . . , I . to x . . . - . . ' . . . . . . spacing . . . . . . . . "o.c., span . . . . . . . . . . ft, Size, roof rafters or beams " x . . . . , `. . . . . . ", spacing , . . . - C/- - . . . "o.c., span . . . . ,.1 . '7 ft- Exterior finish . . . . �% ./� . . . .+. . .+. .x . . . . . . . . . . . . . . . With what material? . . . . . . . , . . . . . . . . Finish of interior walls ASA e. e :T1 *!4 c jr� . k . . . . . . P,H . ,n . _ . If garage is to be attached, of what material is wall between garage and main building to be constructed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r . . . . . . Is there to be an opening between ,garage and building? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kind of heating system . . . . . . ?� t: .T.r , . - -. . . . . . . . . . . . . Oil burner or coal? . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will a flue-lined chimney be provided? . . . . . . . . . . . . . . . Depth of chimney foundation below grade . . . . . . . . . . . . . . . .. . . . . . . . . . . Height of chimney above roof . & . . m m . . & . . . . . . d d . Md . . d . . Will there be a fireplace? . . . . . . . . . . . . . . . . . . . . . . . . . Depth of fireplace hearth . , . . . . Will a toilet be installed? . : . . . . .cwl, 5!E. .'S. . . . . . . . . . . . . '. . . . . - . . . . Will a kitchen sink be installed and connected to water supply? . . . . L1 . � S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Water supply (public water supply or pump) . . . . . . . . . . . . . _ Distance of cesspool from any private well . . . . . . . . . . . . . . . . .!te oe, ? , . . . A#J 0. 4 .P."` ,'1!t ' , Ir A).OA K Will drainage system be provided with required traps, cieanouts, and vents? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Town of Queensbury AFFIDAVIT County of Warren State of New York I swear that to tt bii of my knowledge and belief the statements cfBntained in this application, together with the plans and specificarioos suh- mitted, are a true and co.a. lete statement of all proposed work to be done on the deuxibeel prenusm and that all Provisions of the BUILD} ING CODE, THE ZONING ORDINANCE, and all other laws pertaining to the propo"d york shall be cornpli wi h, whether specked or not. and that such work is authorised by the owner. Sworn to before me this Signaru��~� WR' , j CUNUW NE R. ON6 �AGEFIT, wRCHiT --�' - - ---� , T TUR dayof. . .. . . . .. . .. .. . . .. . . . .. .. .... . .... . . .. .. . . .. . 19. . . . . . NOTARY PUBLIiC. WARREN COUNTY, N. Y. SPECIAL CONDITIONS OF THE PERMIT: By .. . . . . .. . . . . . ... . ... .. .. .. ..... . . . ._ . . . . . .__.. . . . . . . . . ..._ . . ... . .. _. .... .. .. . .. TOWN OF QUEENSBUR.Y WARREN COUNTY ■ NEW YORK Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . ANSWER ALL of the following : I . Gross floor area r- y V T 2 . Type of heat 4f c. • C - 3 . Is the building mechanically cooled ? 6Z..47 4 . Percentage of area of windows and doors A . over 16 % Only 1 . U value of gross area of walls , roof / ceiling and floors exposed to ambient conditions 2 . Floor over heated spaces YES NO a . Are foundation walls insulated ? "YES No 1 . If YES , what is the R value ? 3 . Slab on grade YES a . If YES , what is the R value of insulation around perimeter of floor ? 4 . Is basement heated ? YES NO a . R value of insulation 5 . Type of insulation B . Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions_ 2 . R value of exterior walls 3 . R value of glazed area 4 . R value of doors 5 . R value of floors over unheated spaces 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab s . R value of heated basement/ cellar walls ( above grade ) 9 . R value of heated basement / cellar walls ( below grade ) 10 . Type of insulation C . C_ontrol $ � 1 . Thermostat maximum heat setting D . Duct Systems 1 , Is duct system installed in unheated spaces ? YES NO } a . If YES . R value of duct installation b . R value of duct in other areas E . Piping Insulation �;r 1 . Size of hot water or cooling carrying agent pipe t� Ci Pe 2 . R value of pipe insulation .r'oi era F . Service Water Heat ! o 1 . Performance efficiency 2 . Temperature control setting maximum G . For Swimming Pool Onl �r 1 , Maximum heating Telephone No . 2 ( applicant s sig azure ,_� ,� TOWN OF QUEFNSSURY BUILDING & ZONING DEPARTMENT SEhTAGF DISPOSAL PERMIT APPLICATION 1 . Owner ' s Name +/" n , C� M !;�o Address- ri 1. rJ "y'1 J P C iA r> xN 5 G Ad � Telephone No . 2 . Property location_ C. k dA r ( ,S T> re . J e9 3 . Name of person or firm responsible for installing system mot.) it , L e ox. 'r's Telephone No . _ "� � 2._ 40!v ce", 45r�, Addr e s s ee a 17 r"Lf, 71a 4 <� . � - 4 . Number of bedrooms ( residential buildings only ) 5 . Daily flow, gallons/day 6 . Septic tank capacity C.) _ gallons 7 . Topography : Cflat , rolling , steep of slope 8 . Nature of soil and depth •1 c� 9 . If ground water , bedrock or impervious material is apparent at what depth does it begin? ft . 10 . Percolation test : A is required g is not required C If required what is the rate minutes/ inch 11 . Water supply : unicipa1 , ell , other 12 . Type of system proposed : rywelIF ile field , other Any contractor , corporation , individual , etc * engaged in the construction of a sanitary sewage disposal system who covers they same before inspection , does not have an approved permit , or varies from the approved application will be subject to a penalty of $ 250 as provided for in Section 6 . 010 of the Queensbury Sanitary Sewage Ordinance . Date /."ram f 9 - -fir s 2 �'s�.gnatur� appl i ante On separate sheet of paper submit a diagram of the proposed septic system with all dimensions , including distance from any structure , distance from * property line and domestic water supply , etc . Include all dimensions of the system itself. Form 3 -82 .Jaw" a/ Quee" Ji"ry BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME e �j Gt he ec � LOCATION ih�y �zj ,r}'") 1 C !4 of / a Date Permit No . S,4 cres APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer. Rough Plumbing Relief Valves Ext . Porches Finished Floo `"'� Interior Trim r stairs & Railin i Cellar Drain T11 Concrete Floors Plbg . Fixtures Gar _ Fireproofing Door Closers Smoke Detectors 04a Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL. INSPECTION Final Building Survey Next scheduled Inspection ( call when ready) Remarks- - 6 . 6 ) /jIL- `s C�icr� r.t C^ r- oAf Building Inspector 6/86 and-v1 gown o� '�ueen .f� ttre� BUILDING and ZONING DEPARTMENT Say and Haviland Road, R. D. 1 Box 98 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME n A4oL o s)eA - LOCATION ,/ (Q4, &A 4.5 QM( VL DATE �/ 'PERMIT NC & 7 op soiIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch - TYPE of SYSTEM : Absorption field , to� ngth r� Length of ea,�h--Clench Depth �enches ' Siz of gravel SEEPAGE JPITS{Number of ) Size In ft. X :L—ft. Gravel 81xe ` PIPING : _ Size Type Bldg . to tank , ( _ Kc" _ Tank to dist. box Dist, box to field/ Openings sealed? YES NO Partial LOCATION/SEPARATIONS : Foundation to tank �ft Foundation to absorption j,p ftrf Absorption to lot line ft . Separation of pits 2t ft. MIN s ON OF SYSTEM ON PROPERTY (cixcle one) - Rear - Left side - Right -side TS : W&Cr io p c5 cv s !o cJ hI- .SYSTEM USE APPROVED YES NO Bui ding4sp r 01/86 and V1 i THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 41 STATE STREET. ALBANY. NEW YORK 12207 Application No. on file 009372 86 mad bete �t� g. THIS CERTIFIES THAT $6 t named an the atom" OPrl�t"on Ku ••� :,s tl ap..a•l•es 4f E only the electrical equipment as described below and iuscra lrsced b7 the applicant George Ramoska , Mlchael Driver Glens Pa111s , New York Section Block Lot 2$ in the following IocaLion; Basement ❑ lat Fl. ❑ Ll Znd Fl. Otolde s and found to be in complfonce with the requirements of was examined on this Board. S alft RANGES COOKING DECKS CTVE R NS DISH WASHERS E7iMALIST FANS _ MILTURE XTURES OUTLETS ACLES SWITCHES HCANDESCENT nuonscEHT AMT. K. W. AIM. K. W. AMT, K.W. 1EAhT. K• HEATERS s�s � DRYERS FURNACE MOTORS WTUwE APPLIANCE pWVDl.ES RFC SPECLAL PT TIME CLOCKS lKL utclTL AMT, wATTs AMT. K. W. oK H. F. GAS H. P. AMT. No. A. W, G. AMT. AMP. AMT- AMr'S. TIIANS. AMT. H. ►. IiO. OI' tTAT a R y 1 C E S f A W. G- SERVICE DISCONNECT MEl or Na. of NEUTRALS os NEVTRAT RIQ.OP 1 2�w 1 1 Sw 9 / sw 3 t 1W HK). PERCGHd. or A . CorID. NO, oK HI-LEG of HW1 1 G x AMT. AMP. TTPt EQUIP. 1 2i30 CB 1 Q'THER APPARATUS: Joseph P ]Kor+�Lls P O 49 General Del*verY SRANCH MANCREIt A Cheetertowa so New York 12817 M Per This certificate must not be altered in any manner; raturn to the office of the Board if incorrect. Inspectors ►nay be Identified by their crederTtials. LTERED IN ANY MANNER COPY FOR BUILDING DEPARTMENT . THIS COPY OF cERTiFICATE MUST NOT BE A - -- -- - - TOWN OF CUEENSBU RY Building Department 4upectors Report Datc Name .�Gl lc ifr�t�r �tT'� Permit No. n o a W�atfacyr Remarks kk Excatia Lion Footinq Forms Fpotin & Piers Foundation 60000 Cement Coat Water roofin BacJkfill Final Surve Framin Sheath-In Roof Felt Roo-fin Siding Masonry veneer RoucTh Pl Relief valves Wall Board Ext . Porcnes Finished Floor Interior Trim .Stairs 8 Rail.in s r Cellar Dr . Tile Concrete Floors pl . Fixtures Gar , Fireproofing Door Closers chimney Water Meter Inst . Septic Approval- Foundation Insulation Walls Ceiling wilding nspectar REMARKS 'P(`}( eZ1D 0 '7 C(A5 _ 7 3 'I-L- TOWN OF QUEENSBURY Building Department !/ ln"met o Report Date lei Na me 441 ctl jew 61 AC-,S perma Na. W egahaw .' Remarks Excat7"a t.xan Footing Forms Footing & Piers Foundation Cement Coat waterproofing Backfi.l l Final Surve Framin Sheathing Roof Felt Roof#n Siding Masonry Veneer Rough Pl Relief valves Wall Board Ext , Porches Finished Floor .Interior Trim Stairs & Railings Cellar Dr , Tile Concrete Floors P3 , Fixtures Gar . F#re roofin Door Closers Chimne water Meter Inst , - Septic Approval _ Floors Insulation F60ndati6ri Walls Cei.I.i n �Tjaz I BuileingIrnspector REMARKS Avo uff- BUILDING DEPT. COPY OF APPLICATION FORM 46-ELe NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUi LDI NG DEPT_ WHEN RE QUi RED, TEMP. ss DATE CITY OR VILLAGE TOWNSHIP ;� .' y_r ._ ^,Ja COUNTY STREET AND NO. OR ROAD AND POLE NO. +P31 r rg , ti •' I S ?:} yt _ POLE NO. BETWEEN WHAT TWO CROSS STREETS IS C PREMISES LOCATED? a Jy F ] #j F n Af7 +. SECTION BLOCK LOT OCCUPANT'S _ BUILDING NAME I �N fc9 OCCUPANCY NER'S NAME '"_'AND ADDRESS ze" v J G s 1� 02 TEL. a"# - CuftR V SUPPL IEp r FROM THEIR N. f y. �{ /"-'� j/ OFFICE �— BDEFECTS SUILDING NEW OLD IS NEW ADDITIONAL Q REMOVED C1 LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS LamptR lxturoa III iaepteclea MOTORS HEATERS CIRCUITS OF FINE USE Luca CIRCUITT S ONLY tion Side Attach't H.P. Watts A-W.O. Ceiling Wall Racep'Ia Switch Pendant Bracket No. Type Each No. Each No. Gauge INSPECTION '"• Our Sub- base SAW nsant tat El. god PI. 3ird FI. RFMAR KS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. ThiS aispUCati on is intended to cover the above-listed equipment to be inspected but if at time of Inspection there is found additional equipment not above Iistad, You are authorized to make the inspection and adjust the fee to corer the additional equipment, as provided by the applicant. SIZE OF ELECTRIC SIGN TOTAL MAIN$ R .- FEEDERS LAMPS WATTS CHARACTER EXPOSED GAS TUBE SIGN OF WORK ri.%, - ; ,• � r- CONCEALED TRANSFORMERS OF VA WORK TO BE (NUMBER) ICAPACITYI STARTED COMPLETED SIZE OF SIGN SERVICE OVERHEAD UNDERGROUND ENTERS MAKER BUILDING I OF SIGN INSPECTION REOUESTEO ON OR AS NEAR AS POSSIBLE NEW El OLD AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION, ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. PRINT NAME AND ADDRESS NAME OF -} {r _� DATE OF APPLICANT r-J faf f- Jr. [f:. .�/ Ti' rt,,. /r"1rc. rt'[ F �?.� F'' .J APPLICATION x1 STREET ADDRESS 1� �' .r TELEPHONE { r — CITY OR T-y X `� i.i �..JL JA )t3 ZIP LICENSE NO, PAST OFFICE /°��. xi- CODE -'— J WHEN APPLICABLE ne EL [REV_ V85) A SEPARATE APPLICATION MUST BE FILED FOR EACH: SEPARATE BUILDING o � ep Q �� 10 p °yam , �YR� 6 ir . $� + R � O i i 4 f I r np i f I } I , r f ' GEORGE KUROlSAKA JR.. P,E. BUILDING 'SYSTEMS CONSULTANT pOlur ..WF1'Y BO% NO, 600 GLEm r^tj 'm NEW YORK 1290 t , 1519} 792.1522 13 ARBUTUS DRIVC .. OUCENS13URYO N. Y. 12801 PHONC Sf6 7971 'lSSS BUILDING IN:SPEcTOR Town of Queensbur-y re : Factory Manufactured Home Town Hall Installation Certification. Queensbury , New York 12801 Attention. ' Mack Dean ryes.- sir ! This is to certify that I have observed and inspected the installation of a rrFactory Manufactured home'! ; as defined by the New York State Uniform Fire Prevention and Building {Cade , Chapter D - MANUFACTURED HOUSING , Article 2 - FACTORY MANUFACTURED HCMES , as applicable to your local building regulations ; there appeared to be no apparent structural damage to the units , due to or attributable to the transportation or loading/unloading of the units , herein- after described as follows ; Date of Installation : rt/i� Site Location: /Vfe-x�• 5 yi2/ 4..Z.Community: Town Town of Queensbu.ry County: Warren Manufacturer/Supplier : R f TZ- CRAFT CARP or PA INC. A ddres9 s : Pe 0 . BOX 70 MI FFL I NBURG, 'PA 17944 Ins ignia Serial No. �^�, -7 7 -] Plan Approval No. f `.f �y ► Z_ Manufacturer "- s Model/Component No . : -- -- . �� or Date of Manufacture : f d rr� 1 Z,4 lj S�r C] 71 trAlakS Installer/Supplier; LAMPL I GH TER HOMES I have also examined the approved Plans & Specifications for the abovenmentioned "Factory Manufactured Home" , and to the best of my knowledge and belief , this r'Homet' has been installed In accordance with these approved Plans & Specificati-ons , and all other applicable laws codes , ordinances standards &/or regulations . CD F N,e ;`�r. 6� Ku�oe '�' �- Res tfull s mit ed, o 0 GEORGE KUROSAKA JR . , P . E . cc : st '� NYS PE Lic . No. 35869 a.a M4 TSbb9 ,��'