1987-482 +CERTIFICA 'Tr, OF OCCUPANCY
TOWN OF QUEEN58URY
WARREN COUNTY. NEW YORK
21794 ( 5 � 1 w !Z Date 19
Tlxia is CO certify thac work requested to be done as shown by P'erinit No. 87-482
has been completed.
This structure may be occupied as a Modular Home
ration far . Mud Pond Rd . & Asure �k-� }.
Owner Edxwil Roberts
By Order Town Board
74'OW" 'I OF QUEENSBURY
Building & Zoning Inspector
BUILDING PERMIT
TOWN OF QUEENSBURY �
Na. 87-4$2 �
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Edwill Roberts
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OWNER of property located at Corner Mud Rd . & Asure (Lot 2 & 3) Street, Road or Ave. i
w nr
in the Town of Queensbury. To Construct or place a Modular 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 Queensbury Building and Zoning Ordinance.
1 . OWNER'S Address is
# 1 Buckley Ave .
Granville , N . Y . 12832
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2. CONTRACTOR or BUI LDER'S Name o
G
Simplex Industries m
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3. CONTRACTOR or BUILDER 'S Address
Scranton , Pa .
4. ARCHITECT'S Name
C43
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5. ARCHITECT'S Address
CL
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6. TYPE of Construction — (Please indicate by XI
{ 1 Wood Frame { ) Masonry { T Steer f Y w
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7. PLANS and Specifications
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No. 24 ' x 40 ' Modular home , per plot plan , specifications and application
Including * septic system and drive way permit .
8_ Proposed Use
One--Family Modular Home
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$5 . 00 C/O
19
$ 8H.
February 8
70 . 00 Febru 1 , 19 ' `
PERMIT FEE PAID — THIS PERMIT EXPIRES
{If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the CT
town cf Oueenslwry before the expiration dare.} E
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Dated at the Town of Queensbury this 24th Day of July* 79 87
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SIGNED BY ���+'� � � �9't,.� �-ar^ for the Town of Queensbury 8
Building and Zoning Inspector
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-----------------
/ TO BE COMPLETED BY BLDG � DE T .
Application No . TOWN ;}F
`NCue rtdhLire� .Permit Issued 19 ; w .Ec+kSv ._BUILDING and ZONING DEPARTMENT Permit Expires 19Lo
' t!
Bay and i-laviland Road, R. D. I Box 98 Zoning Designation �r
(]ueensbury, New York 12801 variance No . JUL 2 QI
' - Site Plan Review No .
' 1 Approue by +EUILDING a C:C)DE D$
GV APPLICATION FOR
i e" C> /
PLUILDINC AND ZONING PERMIT 1,
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 : ( ---
P . O. Address f �' ] . 4
r ry Tel . Cw� LS
Property Location : + C5c 77z.� W�- 4 -1- c,Q , y,, J. 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 :
Name P . O . Address Tel , No .
Name of builder -R �
�! ' 1GdAddress l.�rP + 1 ` 7`?�f - Te . �
Name of plumber a _ T• Tel .—_._. 5� Address �
Name of mason ��,y,,. "-" Address fir. Tel .
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 ,
, ,(ago 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
FOR DEMOLITION PERMIT , STATE SIZE AND whether interior or corner lot . Show location
LOCATION OF STRUCTURES AFFECTEDa of water supply and location and configuration
* of septic disposal area ,
,f COMPLETE INFORMATION REQUIRED BELOW ,
- - - - * Size of property , 4� 5 ft X .iC•`i_�_ft _
Existing building ( s ) Size�ft x
PROPOSED BUILDING AND USE : * Existing building ( s ) Use
Size of new structure =ft x L'} ft
Foundation-pier/slab/crawl/partia fu Proposed building, distance from property line
( circle one )
* Front yard (;3 C-) ft Rear yard_ -7( r ft
No , of stories (habitable space ) � Side ands
Height ( grade to ridge ) _ // ft . * 1' a d rt and £t
If residential , no . of families * If on corner , setback from side streetr 7 ft
No . of rooms ( excluding baths ) '+ OCCUPANCY INFORMATION
No , of bedrooms
Noe of bathrooms * PRIMARY BUILDING -
'� * 7
Primary heating system One family dwelling
* 1^ryo family dwelling _
Type of el
No . of fireplaces to be instal ed � Multiple dwelling / Number of units
' permanent occupancy
� /� *
Will a wood stove be installed? C' `} * Transient occupancy
Central Air conditioning . [� Business
BUILDING STYLE, PRIMARY STRUCTURE Industrial
Other
9Ra m
ised ranch Mansionsion Duplex
Ranch Contemporary Log cabin * 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 car/ car
( CIRCLE ONE PLEASE } * Attached garage/one car/ two car/ car
Private storage building
ESTIMATED MARKET VALUE OF * Other
CONSTRUCTION
INFORMATION ON BUILDING, SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETED !
Form BPA 4/86 and-vl
i TOWN OF QUEENSBURY
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 :
1 , Gross floor area
2 , Type of heat E.
3 , Is the building mechanically cooled ?
4 . Percentage of area of windows and doors �Zje
A . Over 16 % Only
1 . Uo 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 NO
a , If YES , what is the value of insulation around
perimeter of floor ?
ri . Is basement heated ? YES NO
a . R value of insulation
5 , 'Type of insulation ✓V � -
B . Under 16 % Only
1 . R value of roof and floors exposed to ambient conditions_
2 , R value of exterior walls - �� � �tc C -y• r> n, ,�.�<,,_ .e....t-� , r
3 , R value of glazed area G-✓Cx,
4 , R value of doors —
5 . R value of floors over unheated spacesjoi
6 . R value of slab edge insulation - unheated slab
7 , R value of slab insulation - heated slab
8 , R value of heated basement cellar walls g --
/ ( above grade ) � y� S
9 . R value of heated basement /cellar walls ( below grade ) Q -
10 . Type of insulation
C . Controls a
1 , Thermostat maximum heat setting [�
D , Duct Systems
1 , Is duct system installed in unheated spaces ? YES
a . If YES , R value of duct installation
b . R value of duct in other areas
E , Piping Insulation
1 , Size of hot water or cooling carrying agent pipe 3 9r
2 . R value of pipe insulation
F , Service Water Heating
1 . Performance efficiency_- - 14 ZO
2 , Temperature control setting maximum C7 °
G , For Swimming Pool Only
1 , Maximum heating J -
Telephone Now 1 - rY k o61&-�
( applican ' s signature )
APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATEi i f /
LOCATION OF PROPERTY FOR INSTALLATION � ,� �a� 0 -1 QC-t2-•c.s--a..2.
Owner's Name: 3G tom_,-cQ k a Telephone:
Address:
Installer's Name: Telephone:
Number of bedrooms (residential only) _._ _
Total daily flow (compute @ 150 gal per bedroom) i
Topography: circle one: Flat Rollm Steep Slope % of slope _ }
Soil Nature: circle one San Loam Clay Other { Depth: feet
Ground Water: At what depth? Z ,;2-- feet
Redvo�ck or Impervious Material: At what depth? i 43 C-> feet
Percolation test: circle one: MIA7 require required / rate in in. inch.
Domestic water supply: circle one: Municipal W ell ther
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption � Z ,22 to feet
PROPOSED SYSTEM: Septic Tank D gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench j-'D feet / Total system length _ � 3 G feet
SEEPAGE PIT(S) : Number of A264j6 / Size each feet by feet
Size of stone to be used # "'� 2- / Depth or Thickness /� feet
IMPORTANT
...P'lease...LIST NEW EQUIPMENT TO BE INSTALLED
(over)
PAA
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME 1 C� —e 1
LOCATION toln ja - �y ,I
DATE CW?J/—=� PERMIT NO.
SCIL TYPE - and Cda )- Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field , total lel "'
Length of ea h txenc
Depth of tire ch
Size of grav _ �^
SEEPAGE PITS4 umber of
SIZe- ft. -ft
Gravel size
PIPING : Size Type
Bldg . to tank & f A J `
Tank to dirt_ box
Dist . box to field
Openings sealed? S NO Partial
LOCATION/SEPARATI S :
Foundation to tan ft.
Foundation to abs rption
Absorption to to line f (�*
Separation of p ' s
LOCATION OE.. SYS ON PROPER circle one )
Front - ear - Left side - Ri t side --
CCIKMENTS :
SYSTEM USE APPROVED YES NO
Sui ding In_ ec }r
01/86 and vl
+ _JOurn 01 Q" een3 ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R, D, 1 Box 98
qj Queensbury; New York 12801
SEPTIC O i S SAL- T_EM�AINSPECTION
LOCATION 2 . '- ��1 �� r
DATE / PERMIT NO .
SOIL TYPE - Sand - Loam - Clay
Percolation Test Required? Y S = NO
Percolation rate - Min/Inch
TYPE of SYS
Absorption eld , Iota length
Length of ea trench
Depth of tren es
Size of gravel
SEEPAGE PITS{N of )
size- ft. X ft_
Graved Size Y
PIPING : Size Type
Bldg . to tan]c
Tank to list_ x
Dist . box to ield/pi
Openings se ed? YES NO Partial
LOCATION/S ARATU)NS :
Foundation to tank ft_
Foundatio to absorption ft.
Absorptio to lot line ft .
Separati of pits ft.
LOCATION SYSTEM ON PROPERTY (circle one)
Front - Rear - Left side - Right side -
COMMENTS :
SYSTEM USE APPROVED YES NO
Building Inspector
01/86 and vl
(/ I / BUILDING and ZONING DEPARTMENT
Oil
� ,rBay and Haviland Load, R.D. 1 Box 98
l Iv Clueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME C. & r
LOCAT I ONeggA %
State J '// /� Permit NO .
APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
4�f 'ackfill
Framing lie
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 ELECOIRICAL INSPECTION
DRIVEWAY APPROVAL,,_
Final Building Survey
Next scheduled Inspection (call when ready )
Remarks- � Z�
Building Inspector
6/86 and-vl
fcca�rr II
own 01 Queenjhury
BUILDING and ZONING DEPARTMENT
Say and Haviland Road, R.0 1 Box 98
oueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION aaz
Date f � Permit No . �'
..- ✓ = R D . - NO
v'Footing/Pier Forms �.
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Ven r
Rough Plumbin
Relief valves
Ext . Parches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg . Fixtures
Gar . Fireproofi
Door Closers
Smoke Detect s
Chimney
INSULATIONif
Foundatio
Floors
Walls
Ceiling
FINAL EL TRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection ( call when ready
Remarks- 20
`
Building Inspector
6/86 and-vl
BUILDING DEPT. COPY OF APPLICATION FORM 46-ELr NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED.
TEMIP. s DATE ,/ . f
CITY OR
VILLAGE TCriVNSHIP COUNTY
STREET AND NO. OR
ROAD AND POLE NO. 0 POLE " ..
BETVMEM WHAT TWO
PREMISES S REETS IS
LOCATED? --}*� �- � �.. / / " ." "�'4+� • SECTION ._1' -``i BLOCK '` ' LOT '•''� ��+'
OCCLOPAIIOT'S ,- "� "' BUILDING
NAME OCCUP/1NCY
OWMEWS
AHD ADDRESSE -• ft TEL.
-CUTEff CRT-
ByyPPLifD Ali/ o FROM THEIR ti+?' e^' OFFICE
IBLOIL£N PIG WOECTS
NEW OLD ❑ IRK NEW ADDITIONAL ❑ REFMOVED ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
Flamm" a NUMBER OF OUTLETS L�wp R itwhm MOTORS HEATERS BRANCH
OFFICE USE
Loea- ONLY
tron '$xide AtencWt H.P. !Mats A1M.G.
CeBl..S WaB Reoip9a Switch Platdewt llraipkrx Nee Type Eeelt Ns Estdr Nee Glow INSPECTION
Out-
siW
Bus
bear
Bheer
attpn
min FL
2nd FI.
&d Fl.
REMARKS; LIST OTHER ELECTRICAL DEVICES POW SET FORTH ABOVE: 00 NOT LOSE THIS SPACE.
This application is inwo"d to carer the abore•lisled eyuiprnant to be Wippected but it at rime of inspection there is taurM 'dditiwd oguiwnnaot root ebose listed,
you pre outlhpsued to make the inspection and a lipsul the fee to eoesr the additional equipanant, as Provided by liar applicant.
SIZE OF ELECTR IC 'SIGN TOTAL
MAINS FEEDERS LAMPS WATTS
CHARACTER EXPOSED GAS TIME SIGN
OF WORK CONCEALED TRANSFORMERS OF VA
WORK TO SE INUInIBERI SCAYACITYI
STARTED COMPLETED SIZE OF SIGN
SERVICE OVERHEAD UNDERGROUND MAKER
ENTERS OF SIGN
BUILDING
INSPECTION REQUESTED
BIBLE NEAR AS NEW OLD i l
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES DATE OF
MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION
NAME
AA PRINT OF AND ADORES - Y [ �.�,,� y SIGNATURE
-:57. ,— APPLICANT
APPt WANT eZ. L _ ]G..:_ �'��� .iti lir'_1 /S. OF APPLICANT "�-
STREET ADDRESS ` L- � 5 -3`''L '�J^-" " . TELEPHONE #
CITY OR ZIP LICENSE NO.
POST OFFICE CODE WHEN APPLICABLE
as EL (R"y 1/86) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
k
(law
TOWN OF QUEENSB URY
Bay at Haviland Road, Queensbury, NY 12804-9725 (518) 792-5832
December 4 , 1991
Mr . Edwil Roberts
2 Asure Drive
Queensbury , New York 12804
RE : Building Permit 87 - 482
Modular Home
Dear Mr . Roberts :
Through an oversight by this Department , the final
electrical inspection on your modular home as well as the
final inspection by this Department were not completed .
Would you please call us as soon as passible so we
may schedule a final inspection of your residence . The
electrical inspection should have been done by New York
Board of Fire Underwriters . The local inspector ' s name
is John Heaudette and his phone number is 793 - 2851 .
Thank you for your anticipated cooperation in this
matter .
Very truly yours ,
DAVID HATIN , DIRECTOR
BUILDING & CODE
ENFORCEMENT
DR : lm
"HOME- OF NATURAL BEACITY . A GOOO PLACE TO LIVE '"
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