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1987-036 CERTIFICATE OF OCCUPANC�' 4 TOWN OF +QUEENSBURY f WARREN COUNTY, NEW YORK Date Kay 15 19 a r� i This is to certify that work requested to be done as shown by Permit No. 7- 36 has been completed. This struccure may be occupied a; � One-�'am i iy vx du l ar 3Jwe 113 n 6 Peg�;vv Ann Road abbrox1mately 112 tulle east or Wesc Mt , Road OwnerJohn Clark _--- I By Order Town Board TOWN OF QUEEMSURY s , Buildit+� �► Zoning Inspector I I BUILDING PERMIT TOWN OF +QUEENSBURY No 87-36 o WARREN COUNTY, NEW YORK = r PERMISSION is hereby granted to John Clark rs II' OWNER of property located at south side Peggy Ann Road Street Road or Ave- approximately 11Z mile east oF West Mt . Road in the Town of Queensbury, To Construct or place a One—Family Modular Dwelling 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 Box 428 c� Corinth Road [' Queensbury , NY 12801 ra 2. CONTRACTOR or BUILDER'S Name a. Lamplighter Homes ° *cl m oiv cro 3. CONTRACTOR or BUILDER'S Address. C RD # 2 Ft . Edward , New York 7d 0 4. ARCHITECT'S Name m w 5. ARCHITECT'S Address 6. TYPE of Construction — (Please indicate by X) (x) wood Frame { i Masonry I ) steel I I 7. PLANS and Specifications m 26 ' x5O ' per plot plan , specifications and application submitted � No. including sewage system . . THE ATTACHMENT OF THE TWO PARTS MUST BE r B. Proposed Use APPROVED BY A LICENSED PROFESSIONA-L ENGINEER . a One—Family Modular Dwelling G N w $5 . 00 C/O $ 91 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES Sept . 1 19 87 (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the F town of Queensbury before the expiration date.) Ci4 [.rated at the Town of Queensbury this 20th Day of Feb . 19 87 SIGNED BY t JCL +`✓ for the Town of Queensbury Building and Zoning Inspector TO BE COMPLETED BY BLDG . DEPT . I Application No . TOWN OF GUEG F /OufJn QueerisC�ul't� Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 Bay and Haviland Road, R. D. 1 Box 98 Zoning Designation FEB x Queensbury. New York 12801 variance N Site Pla Review Nqc" ,�- -- + - cg • �- Appro-VAd gay : SlJ TIDING $c CODEI�EP" APPLICATION FOR ! ! /° OD �' BUILDING AND ZONING PERMIT ! _ A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING * The undersigned hereby applies for a Building Permit to do the following work which will be done in accordance with the description , plans and specifications submitted , and such special conditions as may be indicated on the Permit . The owner of this property is : 2.&.4 - (� l A AC fG P . O . Address "2C> A 4 Tel Property Location : P 7 7 ct , ►� a r► rt TZCs A CA Tax Map Now f / Street n r .or building lot number Subdivision name (if applicable) THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : ,a ern ? f G ,tkry ,c� Mo PA s - fit V U- , ']Ir r�� . Ja K d� t, �7 51 3 - ? 3 J� Name P . O . Address Tel . No . . �,owr. Name of builder S;q ,y� ,p Address �'�.�+� f Tel ,P Name of plumber a Address Tel . ..p Name of mason ,t/_ ! !'.s .. 'rA //d} A +. Address "LS04 to &A in? • � !_ Tel . �� � ry - S` y3 (c+ NATURE OF PROPOSED WORK : * ZONING INFORMATION : Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED , _Addition to a building * drawn reasonably to scale and attached hereto , Alteration to a building * showing clearly and distinctly all buildings , � (no change to exterior dimensions ) * whether existing or proposed and indicate all _Other work (describe) * set-back dimensions from property lines . Give street and number or lot number and indicate * whether interior or corner lot . Show location FOR DEMOLITION PERMIT , STATE SIZE AND * of ,water supply and location and configuration LOCATION OF STRUCTURES AFFECTED _ of septic disposal area . * COMPLETE INFORMATION REQUIRED BELOW . * Size of property / Q t7 ft X ,J`� �Z ft . * Existing building ( s ) Size f ft . PROPOSED BUILDING AND USE : * Existing building ( s ) Use Size of new structure 'L („ ft X J`�D ft Foundation-pier/slab/crawl/partial/full * Proposed building , distancO from property line ( circle one) No . of stories (habitable space) / * Front yard 3 ft Rear yard ft Height ( grade to ridge ) ,Ices £t . * Side yards D ft and ft If residential , no . of families If on corner , setback from side street ft No , of rooms ( excluding baths ) / * OCCUPANCY INFORMATION Now of bedrooms Now of bathrooms - - ..� �. PRIMARY' BUILDING - ,� One family dwelling Primary heating system J f, �r2 , c �- Two family dwelling Type of fuel 1AQ 'r'I- % * Multiple dwelling / Number of units No . of fireplaces to be installed_ Permanent occupancy Will a wood stove be installed? ,,./,g * Central Air conditioning? ,,,, � * Transient occupancy s -�----- Business BUILDING STYLE, PRIMARY STRUCTURE Industrial n c h Contemporary Log cabin * Other ranch Mansion Duplex if addition , what will use be . Split. level Old. style Bungalow Cape Cod Cottage Other * ACCESSORY BUILDING- Colonial Row Town House * Detached garage/one car/ two oar/ car ( CIRCLE ONE PLEASE ) * Attached garage/one car/ two car/ car * * * * * * * * * * * * * * * * * Private storage building ESTIMATED MARKET VALUE OF 'f 'Other CONSTRUCTION INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETED ! Form BPA 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type ' of construction , wood frame , fire safe , etc . &JJ015 cc /1/c' 1gen Q Will any second-hand or ungraded lumber be used? If so , for what ? .�rJ r Foundation wall material e`C' -E' Thickness Depth of foundation below grade (to bottom of footing ) Will there be a cellar?Heated or unheated? UhL [fe#,fxy&lFloor sq. footage 3 sq ft Will there be a basement? ,,,.x4, Will any portion be used as living space ? y+rZ> ( If so, what portion? sq . ft . - - 'Type of use? 'Type of roof - P'--�� flat/shed/other Material of roof Size , wood studs_ spacing "o . c . length S� ft . Joists ( floor beams ) 1st . floor 2 A10 RIX IF spacings"o . c . span / 3 ft . Joists ( floor beams ) 2nd . floor "X spacing '"o . c . span ft . Overiays ( ceiling beams ) "X spacing e//"o . c . span�3 _ft . Roof rafters - _-"X 4 IF spacing 6/ o , c . span r ft . Roof trusses (pre-engineered) spacingsy -" o . c . span /3 ft . Exterior wall finish_ S' � G Of what material? Interior wall finish If a garage is to be attached , describe materials to be used for FIRE SEPARATION : - Is there to be an opening between{garage and dwelling? If so will a Fire-rated door , enclosure , and self-closing device be provided? Will a flue-lined chimney be installed? Height above roof ft . Depth of chimney foundation below grade ft . Depth of fireplace hearth ft . in . Water supply - Municipal or private well c .� / SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties ,y 1Q ft . (A separates application is necessary for any repair or new installation of septic system) Town of f Warren A F F I D A V I T STATE OF NEW YORK County of Warren 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 authorized by the owner . f SWORN TO BEFORE ME THIS Signatur -owner " s a fycn3_ev.�' �ractor _f :day of '4' Notary Public , Warren County , N . Y . * IF * * * * * * * * * * * * * * * * : * * * * * * * * * * OF * * * # * x SPECIAL CONDITIONS OF THE PERMIT : By APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE .f 52 LOCATION OF PROPERTY FOR INSTALLATION G G t 0C.Or e~ ILL' 0 a Owner's Name: a,> fl , C �,q A lG— 'Telephone: c 2p 7 4 Address: 90 :4 Via /Z . TZ, 2a A C( to S Installer's Name: uj • itA. .L4 I/ e Telephoner 7 9 �Z — e9 cf c ` Number of bedrooms (residential only) Total daily* flow (compute @ 150 gal per bedroom) G' Topograpphy: circle one: Flat Rolling Steep Slope % of slope Soil Nature: circle one: and Loam Clay Other / Depth: feet Ground Waters At what depth? ,+//ram feet Bedrock or Impervious Material: At what.t depth? i � feet Percolation test: circle on not required ro uired / rate min. inch. Domestic water supply: circle one: Municipal Well Other ZVg ,z ,c , i/P / IF domestic water supply is a Well: Separation: Watersupply from Septic absorption _ feet PROPOSED SYSTEM: Septic Tank /07�7f) gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench 6? ? feet / Total system length ;,�, &�- feet SEEPAGE PIT(S) : Number of / Size each feet by feet Size of stone to be used # 2 j Depth or Thickness Z feet IMPORTANT ...Please...LIST NEW EQUIPMENT TO BE INSTALLED * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * (over) Section II Septic System Inspections: A. All applications for septic system installation, alteration or repair, as required by the Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Building Department at least 24 hours before start of construction and shall include a plot plan showing: 1.) the proposed location of the system 2.) location and distance to lot lines 3.) location and distance to structures 4.) location and distance to any water supply 5.) size and dimensions of all tanks, distribution boxes, the fields and/or drywells B. No system shall be covered before inspection and approval by the building Inspector. Failure to comply with this requirement may result in the uncovering; of the system by the installer and a fine of up to $250.00. C. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an approved system , a new proposal must be submitted to the Queensbury Building Department before further construction. I have read the regulations above and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal CIrndinance. Signature of responsible person: � _ _ 5 Z Date: -- ! 29 -7 Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New Fork 12801 (518) 792-5832 SETTLED 1763 , ' ' HOME OF NATURAL BEAUTY . . A GOOD. PLACE TO LIVE THE NEW YORK BARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY �A.Y W 41 STATE STREET, ALBANY, NEW YRf&?A1Q7 /rye airy` Date June 4 , 1987 Application ,No. on fife LiU7Ui I A U 8 V V 0 3 THIS CERTIFIES THAT only the electrical equiprrsent ae described below and introduced by she applicant named on the above application ntnmber in the premises of John Clark, Peggy Ann Road „ Queenebury . Now 'York in the following locatin Outelde 51�Y3�7 Bosement � lat Ft. ❑ 2nd Fr. Suction Brock Lot was examined on and found to be in compliance with the requirementa of this Board. FIXTURE FIXTURES RANGES 1COOKING DECKS I OVENS I DISH WASHERS EXHAUST FANS � OUTLETS EPTACI# SWITCHES HHES INCANOE3CEPIT FWORESCEWT V AMT. K. W. AMT, K. W. AMT. K.W. AMT, K_ W. AMT. H. P. 4 1 + DRYERS FURNACE MOTORS FUTURE APFUANCE FEEDERS SPECIALRIIVFT TIME CLOCKS RILL UNIT HEATERS MULTIdOWLST DIMi"MEaS AMT. K. W, OIL H. P. GASH- P. AMT. NO- A. W. G. AMT, AMP. AMT. AMPS. TRANS, AM NO. OF FEET T. H_ P. SYSTEMS AS AMT. WAIFS i� SERVICE DISCONNECT NO- OF S I R V I C E AMT. AMP. TYPE 1 ,!' 3W 1 X 9W 3 X 3W 3 X 4W �'�" #PER%C6t4o CW CC- CCMD. NO. # NI-LEG •HWI-'LEG NO. OP NEUTRALS OF NEUTRAL 1 204 cla 1 x 4/0 2 OTHER AFFARATUS: +{} s ?" Patrick J . Dashnrru 10 Marine Dr1ve BRANCH MANAGER South Glens Falls & New York. 12803 Per S This certificate must not be altered in any manner, return to the office of the Boord if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT_ THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ' r , BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R,0- 1 Box 98 i pueensibury, New York 12801 1 BUILDING INSPECTOR ' S REPORT NAME L '1 Ci f� LOCATION Imo , I j Date Permit No . I � APPROVED - YES NO y Footing/Pier Forms ` Foundation ,ve waterproofing qq Sackfill 7 Framing Roofing I Siding i Masonry Veneer I ~ - ,ugh Plumbing } .x� Reef Valves EX . 'Obxch4eLL Finished IPloors Interior Trim stairs & Railings Cellar Drain Tile _ Concrete Floor6s Plbg . Fixtures Gar . Fireproofing Door Closers I j Smoke Detectors Chimney INSULATION : ; Foundation Floors walls Ceiling FINAL ELECTRICAL INSPECTION RIVEWAY APPROVAL } inal Building Survey Alext scheduled inspection (call when ready ) Remarks- f jj i lBuilding inspector q �jE3E� and-vl } BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R- D7 1 Box 98 Queensbury, New York 12801 BUiLDING INSPECTOR ' S REPORT NAME_ <:::� z LOCATION ,Q� � .,J,.y Date.�,/�/� Permit NO ** X. :':7!3(e — APPROVED - YES NO rootinglPier Forms Foundation Waterproofinan Backfill Framing Roofing Siding Masonry Vene Rough Plumbi Relief Valve Ext . Porches Finished Flo Interior Tri stairs & Rai Cellar Drain Concrete Floors Plbg . Fixtures Gar , Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTIONr DRIVEWAY APPROVAL ovinal Building 5urveY _. Next scheduled inspection keel,." when ready Remarks- D,, Building s ec 6/ 36 and -vl ._.J'own o� �ueens6eere� BUILDING and ZONING DEPARTMENT !! Bay and Waviland Road, R. D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL, SYSTEM 1,14SPECTION NAME .1elpw 1?`re I LOCATION r? c F' 6t of ti S� DATE t//49J - PERMIT NO. 6 SOIL TYPE ganO - Loam - Clay Percolation est Required? YES Percolation rate - Min/Inch _ Z�P - � TYPE of SYSTEM: Absorption field , total length 24!p Length of each trench ` . Depth of trenches Size of gravel JW`3 SEEPAGE PITS{'ember of) Size- ft. X _ ft, rn Gravel size PIPING : Size Type Bldg . to tank 1t Tank to dlst . box Distv box field Openings sealed? led? S I+I Part ' 1 j s r L CCAT I ON/SEPA RATION S Foundation to tank 'ft/ Foundation to absorption . Absorption to lot line Separation of pits -�^ f LOCA,T2 YSTEM C]Di PROPER ( c cl-e one) Front Rear)- Left side - Fyp(ght side - CC04MEN I SYSTEM USE APPROVED YE NO lZIN6 Bu ing Inspector 01/86 and vl / 0114 #Irn // �/auvn o/ Q"Oetrd6ury BUILDING and ZONING DEPARTMENT Bay and Hauiland Road, R. D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME �1-0 k V- 6� I Q V- k LOCATION lib DATE ^ �f-�—� � PERMIT NO , SOIL TYPE - Sand - Loam - Clay -_ Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , total length Length of each trench. Depth of trenches I Size of gravel__ SEEPAGE PITS4Number of) Size- ft, X f t, Gravel size - PTP ING : S„2.ZE'- Type Bldg . to tank Tank to d1st. box Dist. box to field/ Xt Openings sealed? e5 NO Partial LOCATION/SEPARATTONS : Foundation to tank U ft , Foundation to absorption tft. Absorption to lot line at) ftc, Separation of wits ft. LOCATION YSTEM ON PROPERTY (circx4e - Alae) Front ear - Ie£t side - Right si SYSTEM USE APPROVED YES f LV(,]' Building Inspector 01/86 and vl ../our" v/ Q"ec," Ji eery BUILDING and ZONING DEPARTMENT Bay and Flaviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME I h L;!I OCATION- 51 _ I- � tir # I?'L�te / Zu Permit No . r '1I 3 (c+ ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Back£ill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors NT Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors �t Plbg . Fixtures_ Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled. inspection (call when ready ) Remarks- G m p if 1 rf e&. *Vf 'ftes - )I. o d x. l w- I -4).10 e_ BuilArng Inspector 8+6 and-vl #-' „_,lowr� v� �iteen3ha.Rrf�t. BUILDING and ZONING DEPARTMENT Bay and Flaviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME )'G LOCATION �&G & 4AA,�tl g7ow�G r7 Date. �r` f � Permit No . // 1✓ APPROVED - NO telooting/Pler Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry veneer Rough Plumbing Relief valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar , Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL X13APECTffiON Final Building Su ey Next scheduled Inspection ( call when ready) Remarks- . 0*0 Building Inspector 6/86 and-vl 4 f,p !- town O/ Q"PiPI"t3l7"ry ff BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R_17. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME J�a h ►a f 4!2J A,F'-ilf► LOCATION s IS P qe !5 !,[.j h oo-c{ _..__ W 611 Permit No . ✓ PR VED - YES NO ( Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing siding Masonry Veneer Rough Plumbing Relief Valves Ext , Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- r -r4 y 07 f �♦f ' C 4 16 <5 Building Inspector 6/66 and-vl BUILDING DEPT. COPY OF APPLICATION FORM 46-EL. NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. TEM{- ed I DATE CITY OR VILLAGE .! TOWNSHIP - j .� fy COUNTY 04,'/ J//_ �^ STREET AND NO. OR 0.0 --y ROAD AND POLE NO.yz ;z I 1- 1. a {..1 i.•' y,,-y t f POLE NO. , 2 BETWEEN WHAT fWU CROSS STREETS is PREMISES LOCATED? SECTION BLOCK d' LOT r ' OCCUPANT'S BUILDING NAME �^ E :I OCCUPANCY OWNER'S NAME - AND ADDRESS ? v rr �-,. y ._. .- f TEL. C—UR1FEi31 SUPPLIED BY 3 / .4 if. f.d z4 FROM THEIR OFFICE BDEFECTS SUILDING NEW ® OLD © IS NEW GJ ADDITIONAL © REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED . NUMBER OF OUTLETS No. of Fixtures BE BRANCH Lamp Reaepucks MOTORS HEATERS CIRCUITS OFFICE USE Loee- t ONLY ion Coiling wall Recapiu'Is switch Pendant Bracket No, Type ESP' No- E:: No. Qa INSPECTION Out- ads Sub- baaa Baer nrsnt ' 1st FI. 2nd FI. 3rd FL REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. This apdicaxian is intended Ia Cover the ahmre-listed aquipmaatt to be inspected but it at time od inspection there is found additional aqu iPM ant not above listed. You are authorized to make the inspection and adjustthe fax to cover the additional equipment, as provided by the Applicant. SIZE OF ELECTRIC SIGN TOTAL MAINS FEEDERS LAMPS WATTS CHARACTER EXPOSED OAS TUBE SIGN OF 'WORK _ Cy y. CONCEALED TRANSFORMERS OF VA WORK TO BE iNUMBERI 1CAPACITYI STARTED r. yt�e OMPLETED SIZE OF SIGN SERVICE ERHEAD UNDE GROUND MAKER ENTERS IBUILDINQ OF SIGN INSPECTION REOUE5TE ON OR AS NEAR AS T J POSSIBLEI NEW 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 DATE OF APPLICANT '%7 _ / /_ - - MOP" v l--- APPLICATION T STR E ET ADOR ESS f TELEPHONE POST OFFICE r'' F'- I / '� zip LICENSE NO. 5.—�'• n.1 . .__ CODE WHEN APPLICABLE 46 EE (sE,.- tles) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING 1CL ' i 1 30 MOM r N3 O t � � 4 ( i~ J 14 t i dwL OIL �► GEORGE KURO�SAKA .TF2.. P. . BUILDING SYSTEMS CONSULTANT APR Z 41987 POST OFFICE Box No, 060 C31 ETiS FALLS, NEW Yt?[ 12009 4518) 792*1z= BUILDING & COOE DEPT. 13 ARBUTUS DRIVE QUEENSBURY, N. Y. 12.80 ' . Prsorre sxa 792 - + 522 BUILDING INSPECTOR TOWN OF QUEENSBURY re : Factory Manufactured Home TOWN HALL - BAY ROAD Installation Certification.. QUEENasuRY , NY 12901 Attention: MACK DEAN $� _ 3(�, Dear sir , This is to certify that I have observed and inspected the installation of a „Factory Manufactured Home" ; as defined by the New York State Uniform Fire Prevention and Building Code , 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 Mnstallation : 312�3�fm Site Location : community: TOWN OF QUEENSBURY County : WARREN Manufacturer/Supplier : RITZ-CRAFT CORP or PA . , INC . Address : P . O . Box 70 MIFFLINBURG , PA 17944 Insignia Serial No. 2 3 7 Plan Approval No. 4 / fy Manufacturer " s Model/Component No. : Date of Manufacture : 7,,/!jo ,00 —;; Installer/Supplier : LAMP, L. IGHTER SALES , INC. I have also examined the approved Plans & Specifications for the abovernentioned **Factory Manufactured Horne" , and to the best of my knowledge and belief , this "Home" has been installed in accordance with these approved Plans & Specifications , and all other applicable laws codes , ordinances , standards &/or regulations ., { KDAa jS Res d tfull rnit e s a GEORGE KUROSAKA JR . P .E w fi4 NYS PE Lic _ No. 35869 v p . J5864 4,� A0r"Lc�SipHP+.