1986-770 s .
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
This is to certify that work requested to be done as shown by Permit No. 86-770
has been completed.
This structure may be occupied as a Mobile Home Dwelling
Connecticut Ave.
Location
Owner Robert S. Batease .
By Order Town Board
TOWN OF QUEENSBURY
Building &-Zoning Inspector
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BUILDING PERMIT
TOWN OF QUEENSBURY
No. 86-770
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Robert S. Batease
OWNER of property located at Connecticut Ave. Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Mobile Home 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. Q'
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1. OWNER'S Address is Box 469 Merritt Road cn
West Glens Falls, NY
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2. CONTRACTOR or BUILDER'S Name
same U1
3. CONTRACTOR or BUILDER'S Address
same
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
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No. 1974 Parkwood Serial Number 495 per plot plan and application r.
submitted including sewage system CD
8. Proposed Use 0
Mobile Home Dwelling m
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$5.00 C/O w
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 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
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 6th Day of November 19 86
SIGNED BY LJL L) 4 4.z for the Town of Queensbury
C�l Ay Building and Zon hg I nspecto
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5,sph of Qdreniiacr
r APPLICATION FOR SEPTIC DISPOSAL PERMIT
BUILDING and ZONING DEPARTMENT
gay anc Ha✓iland Read. R D. ; :: z 9S _
- Nev. `ror' rsaivr fU: /
LOCAT ION OF PROPERTY FOR INSTILLATION aa/% /% -- 4j(.T/,
• OWNER'S NAME .i •
ADDRESS
4077L-47,0 /data - a /4 /zmoo, •
TEL 79.z-7237
1 NSTALLER' S NAME �ic /ee TEL
Number of bedrooms (residential only)
Total daily flow (ccmpute @ 150 ,gal per bedroom) 3O0
Topography Flat - Rolling - Steep slope -(circle one) % of slope .
Soil nature: San - Loam - Clay - Other Depth ft. •
Ground water -At what depth? ft,
Bed-rock or impervious material. - At what depth? r it.
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Percolation test - Not required - Recr.irrti - -Rate - min-inch.
Domestic water supply 'unicipal - Well- - Other
. Separation - Watersupply(if well) from Septic absorption ft.
• Proposed System: Septic tank /W e gal. ( Minimun size, 1000 gal . )
Tile I ielC. - :_C.. j '-c- cy;- ft : Total s}•stem. 2ef.:r :*h f2 )-- f t .
S e e r a';c= f- _ t '_ i ' =.1.c:r of . c i is t- € C : Y.ft f t
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e c'f stc,nE Lc 1 t ac.�: / DrIFth Or +hicrr, Es 02. ft .
IMPORTANT ! !
On a separate piece of parer, suhmit- s diagram t,l the proposed system
with all dimensions shown ; including distance from. any structure ,
distance from property lines and from ANY DOMESTIC WATER SUPPLY or
shore-line of lake, streazn,pond or wet-lands.' Include all dimensions of
the system, itself .
• Y w i ♦ Y Y v • ♦ ♦ r i 1 $ f * • ♦ * • • f • I t
i ; ( ?' .'C)'£E . :G� o t i :I:C C : c):;:
-10 c2'. L6 L YI:eFC G) c77 r(cz4i 'C-'T'e);. .c rf 7hr Town of Cu cvi:�✓r'
SeritcrU 5c occ Lisposcl Ord nc)icc. .
nr,ct:,r�nf %
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TO BE c_:-x.,PLETED BY BLDG. DEPT.
\....7 // Application No.own O Queenibur� Permit Issued 19
tDING and ZONING -' '1 _3: `, .,,
NG DEPARTMENT Permit •Expires 19
_..r and Haviland Road, R.D. 1 Box 98 ZoningDesignation ; '''- ''`' l ,,+' l j'. 1 },i iI_ I I?
Queensbury, New York 12801 Variance No. ;� �{' '"
fa 7_ _ 7 Site Plan Review No. j '}- „b. i4,- ? c
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APPLICATION FOR Approved by:
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MOBILE HOME 6,, �� .���. -x.�' ,',,:=N .'n ?. . ,i- ?1-c,c . .
A
BUILDING AND ZONING PERMIT - ��° "�`
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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: b,$ `T � ` /A?" -
P.O. Address Lac Y 4/65; A41% -W /AG;1 -:s, / y /2 bC r Tel. 75 ?72.E7
Property Location: CG>;r/ .'/),L• • Tax Map No.
Street number or building lot number
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
S• C2,9rrA z
• Name P.O. Address Tel. No.
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Name of Installer Address Tel.
Name of. plumber • Address Tel.
Name of mason Address Tel.
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• MOBILE .HOME INFORMATION: * ZONING INFORMATION:
New Home Placement ., * A PLOT PLAN MUST BE PREPARED AND SUBMITTED, '
-* drawn reasonably to scale and attached hereto,
Replacing existing Home * showing clearly and distinctly all buildings,
Size of new Home /2 ft X (' ) ft * whether existing or proposed and indicate all
* set-back dimensions from property lines. Give
Single wide —,% Double wide * street and number or lot number and indicate
No, of rooms (excluding baths) L,l * whether interior or corner lot. Show location
* of water supply and location and• configuration
• ' No', of bedrooms Z * of septic disposal area.
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No. of bathrooms * COMPLETE INFORMATION REQUIRED BELOW.
Fireplace? C. Wood stove? C * Size of O 0
property- ft X f -
ft.
Foundation style and size: 7 Existing building(s) Size — ft X ft.
�� Piers- No.of )' Size- ft x ft. * Existing building (s) Use
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.b ° "�i Depth below grade , ft.
* Proposed building, distance from property line
FOUNDATION :. Footing size ,j" " X " * f
/� * Front yard Z t� f t Rear yard /5 ft
Wall material /iffe,, c-k r.),,c * Side yards ft and ft
Wall thickness " Height ft.
* If. on corner, setback from side street ft
Total depth below grade ft. * OCCUPANCY INFORMATION
*
Grade to Home floor level ft. * PRIMARY BUILDING -
* * * * * * * * * * * * * * * * * * * * * One family dwelling
* ____Two family dwelling
Proposed date of placement / / * Multiple dwelling / Number of units
Aprax. Va]u�, 9f Home $ CCC ----- * _Permanent •occupancy
_.�.. * ...__TaranP ent oc ruporloy .
Water supply Well, Mt3_rIi i,pa�;` ilus Hess
* Industrial
Septic Permit required? .VcS * Other
/ * If addition, what will use be?
FURTHER INFORMATION REQUESTED •
* ACCESSORY BUILDING-
ON THE REVERSE SIDE OF THIS SHEET .* G Detached garage/one car/ two car/ car
* d Attached garage/one car/ two car/ car
* 6. Private storage--. building
* C Other
* -'_
Form MHP 5/86 and-vl
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. • APPLICATION FOR MOBILE HOME PERMIT, (CONTINUED) •
State of New York Division of Housing and Community .Renewal •
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
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1 . INS IGNIA-.'.SERI;IL NUMBER
2 . NAME OF MANUFACTURER ��%;ldl•L%C96;�
3 . PLAN' APPROVAL NUMBER 2/Z
4 . MODEL OR COMPONENT DESIGNATION •
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5 . MANUFACTURER 'S SERIAL NUMBER• yS';
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6 . DATE OF MANUFACTURE /_S 7(/
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All the above information is to be found on a plate or sticker which
should be affixed to the Mobile Home. Complete above with that information.
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Town of Queensbury AFFIDAVIT
County of Warren STATE OF NEW YORK
• 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. -
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• Signature �� �
• Owner, owner's agent,arcnitect,contractor
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SPECIAL CONDITIONS OF THE PERMIT:
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By
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,...1../a A,lJ.{),..,,.\I\t.1,,..,,..1 iaJ..C.\.lA I,.,CT./..,i•)./.,!_J.,..,I.1 I J.,..\I,! ,..,l.?,..,i 1,!1 I_?!).(.).!J_.L.).,,,_/_a.,,)!..,!.?/�.,.,.,..,/.,/,,.?/,i_,..\,,/J , ,,_ ,
�i 4001939 THE NEW YORK BOARD. OF FIRE UNDERWRITERS
* f BUREAU OF ELECTRICITY —
kJuly 41 STATE o
STREET.ALBANY,NEW YORK 12207 f
0 Date Application No.on file 01 3 1 u 9- 7 A 6 7 1
• 0 THIS CERTIFIES THAT o
k only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of o
Bryan Iiateaise , Connecticut Avenue, Glens Fills , NY, Pole n NM 9 N
in the following location; ❑ Basement ❑ 1st Fl. ❑ 2nd Fl. Section Block Lot
was examined on G/Z 2 J �/n
�7 and found to be in compliance with the requirements of this Board.
k FIXTURE EEPTACLES SWITCHES FIXTURESycu�Y RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS 74.
OUTLETS INCANDESCENT.FLUORESCENT VAPOR AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RE'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
Ij AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS AMT. WATTS
NO.OF FEET
® e
SERVICE DISCONNECT NO.OF S E R V I C E
p AMT. AMP. TYPE METER 1.$2W 1 0 3W 3$3W 3 0 IW NO.OF CC COND. A.W.G. NO.OF HI-LEG A•W G. NO.OF NEUTRALS A.W.G.
EQUIP. PER B OF CC.AND.. OF HI-LEG OF NEUTRAL
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OTHER APPARATUS:
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a Richard Nicholson
Rd. 4 Box 13
Glens Falls , NY 12301 BRANCH MANAGER
. . ....I o
k Per `
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This certificate must not be altered in any menner;return to the office of the Board if incorrect. Inspectors may be identified by their cr •_,_"ials.
Alit INC viir tut At Alt vat mar 1Stvu Alf vlMt1St talitIluviLAltvrtvitvrtvrzlitMgtnl[vitlitl$vWtl7tIIRtWvltvltvrrvttlity am,vitAu1fitWirv[JPrserIf[iilrurvr liffiLMS111
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. -
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BUILDING DEPT.COPY OF APPLICATION FORM 46-EL,NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT.WHEN REQUIRED.
r l '1 ""- !TEMP.# IDATEE J I
CITY OR - j •
VILLAGE TOWNSHIP COUNTY j, , • �/+
STREET AND NO.OR r !
ROAD AND POLE NO. • r e,--,y I POLE NO.
BETWEEN WHAT TWO 1 `+ '
CROSS STREETS IS ,,}
PREMISES LOCATED' "I '`'\"'.,, '� � SECTION BLOCK LOT
OCCUPANT'S 5 BUILDING - \
�, OCCUPANCY '�` •t•
NAME \ \ --. _. '\i_- ..-�.-� `'� -
OWNER'S NAME
AND ADDRESS TEL.#
CURRENT ,. i '\ }}
BBYPPLIED \t; `>,.\.1¶ �;a., FROMTHEIR OFFICE
SBUILDING NEW 0 OLD El IS
DEFECTS NEW ❑ ADDITIONAL Li REMOVED ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
No. Fixtures& BRANCH
NUMBER OF OUTLETS LampfReceptaclesMOTORS HEATERS CIRCUITS
OFFICE USE
Loca- ONLY
Lion Side Attach't H.P. Watts A.W.G.
Ceiling Wall Recep'Is Switch Pendant Bracket No. Type Eech No. Each No. Gauge INSPECTION
Out-
side
Sub-
base
Base-
ment
1st FI.
2nd Fl.
3rd Fl.
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE.
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This application is intended to cover the above-listed equipment to be inspected but if at time of inspection there is found additional equipment not above listed,
you are authorized to make the inspection and adjust the fee to cover the additional equipment,as provided by the applicant.
SIZE OF ELECTRIC SIGN TOTAL
MAINS FEEDERS LAMPS WATTS
CHARACTER EXPOSED GAS TUBE SIGN
OF WORK CONCEALED TRANSFORMERS OF VA
WORK TO BE (NUMBER) (CAPACITY)
STARTED COMPLETED SIZE OF SIGN
SERVICE OVERHEAD ,i UNDERGROUND MAKER
ENTERS OF SIGN
BUILDING
INSPECTION REQUESTED '(% -
ON OR AS NEAR AS i - `,-• .+I
POSSIBLE ,'`4 '\}-. '',.i-t-"^'•, NEW El .- --ALD
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AVOID DELAY BY GIVING FULL AND ACCURATE-INFORMATION.ALL SPACES DATE,OF F
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MUST BE FILLED IN OR APPLICATION M,NY BE.-RETURNED. APPLICATION
PRINT NAME AND ADDRESS d✓ i; _ ,-_,M__ 1/SIGNATURE ;-i z, rf '-,\ `' r .-- -,
NAME OF _ r.% y- -✓�F ../,,•- /� r, . i,;•-'--1; r�-c+ \ _-",�.-,"——.f.
APPLICANT � OF APPLICANT%
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STREET ADDRESS +•'+ TELEPHONE# .-
l _4r: i' t�) 1
CITY OR \I ZIP '--I ( LICENSE NO.
POST OFFICE i-. `-' '�'!-''` -r .�f ~\,,+' -�t '+ CODE '- ` - WHEN APPLICABLE
46 EL (REV. 1/86) A SEPARATE APPLICATION MUST B(E}FILED FOR EACH SEPARATE BUILDING
Jown of Qucen3ur/
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
�S/ C » aleccs C
LOCATION Co ,, 74�� -�
Da e jJ/1 / V, Permit No. (f (p - 77
* * * * * * * * * * * * * * * * * * * * * * *
Se/ = APPROVED - YES / NO
iC Footing/Pier Forms f9/`
/ Foundation /�
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings I
Cellar Drain Tile
Concrete Floors I
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
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Next scheduled inspection (call when ready)
Remarks-
‘(//5)
Building Inspector
6/86 and-vl
Get 7/' a' ///6/0 6 9 •:..o /a--Pri
awn 01 QueeniLur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME -1 7Jih 8 I ci se
LOCATION ( 0)1 h, /7-ll °/•
DATE // /(a /8(9 PERMIT NO. F(O - 7 7 v
SOIL TYPE - — - Loam - Clay -
Percolation -st Required? YES 4111,
Percolation rate - Min/Inch _ 0 - 5--
TYPE of SYSTEM:
Absorption field, total length /3 0
Length of each trench 6 3-
Depth of trenches (-2/
Size of gravel
SEEPAGE PITS{Number of)
Size- ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank KO
Tank to dist. box
Dist. box to field/ t
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption .e- ft.
Absorption to lot line )) ft r}-
Separation of pits ft.
LOCATION OF SYSTEM PROPERTY(circle one)
Front - Rear - Left side - ight side -
COMMENTS:
w (1
T / /
//1( NN
SYSTEM USE APPROVED YES NO
WIZ
Building Inspector
01/86 and vl
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MADE IN U.S.A.
ARCHITECTS' STANDARD FORM