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`I
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
' ; WARREN COUNTY , NEW YORK
t
Date �f nn,
(LLG! ' 19 9I
U
,this is to certify that work requested to be done as shown by Pe it-No. 9f-679
has been completed.
This structure<may be occupied as a s i n a l e family mobile home
Rhode Island Avenue
Locatic *' -
''`� DONALD L. DEAN JR.
Owner :. ,.
By Order Town Board ''
'
TOWN OF QUEENSBURY I:
r d
Director of Bldg. & Code Enforcemgnt
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 90-679
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to DONALD L_ DEAN JR.
OWNER of property located at Rhode Island Avenue Street, Road or Ave. co
in the Town of Queensbury,To Construct or place a Mobile Home
at the above location in accordance to application together with plot plans and other information hereto filed and 'J
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
137 Homestead Village
Queensbury NY 12804
2. CONTRACTOR or BUILDER'S Name
t=
0
3. CONTRACTOR or BUILDER'S Address 'J
Q
-5
4. ARCHITECT'S Name
5. ARCHITECT'S Address
0
6. TYPE of Construction—(Please indicate by X) re
v.)
( )Wood Frame ( I Masonry ( ) Steel ( )
0)
0
7. PLANS and Specifications
No. 14'x70' Mobile Home as per plot plan, specifications and application.
8. Proposed Use
Mobile Home
0
0-
J.
$ 60 00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 4 19 91 re
(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.) 0
CD
Dated at the Town of Queensbury this 4th Day of October 19 9D
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
n TO BE COMPLETED BY I3LUG. DEPT.
i _/uwn of , q�upQqiGur Application No.
BUILDING and ZONING DEPARTMENT Permit Issued 19
Permit Expires 19
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation
Oueensbury, New York 12801 Variance No.. BURY
Site Plan Review No. .-xVtD
•
•
APPLICATION FOR Approved by: •
MOBILE HOME • - . OCT - 21990
PU I LD I NG AND ZONING PERMIT ' a D _ ODDPTDEPT.
* * * * * * * * * * * * * * * * * * . .. :► * . * �► * * * * * : .*
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. 0�nn�� `f
1'"
The owner of this property is: 0,05 I#( . 0/9i/J (.17.Af •
P.U. Address /A,2>er ��/.�,c, ..W.1�c- Tel. :g 7'3
Property Location: _ 27C1 Z27 T 2757 Tax Map No.J2Z/ 9'/ 3/
Street ,:umber or building lot number
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
on�t�( L bg,9� c /37 , sue-�e�� v.2 "' �.c--7G3 . . .
Name •
P.O. Address - Tel. No:
Name of Installer 5, Address • Tel.
Name of plumber S.^vZ Address Tel.
Name of mason L.5:47,4b Address Tel.
MOBILE HOME INFORMATION: * . ZONING INFORMATION:
New dome Placement 1/ 'S . * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
' drawn reasonably to scale and attached. hereto,
Replacing existing Home !Uo * showing clearly and distinctly all buildings,
Size of new Home /y ft X 70 ft . • * whether existing or proposed and indicate all
• * set-back dimensions from property lines. Give
Single w ?e • // Double wide * street and number or lot number and indicate
•
•
No. of rooms (excluding baths) ,, * whether interior or corner lot. Show location
* of water supply and location and configuration
No. of bedrooms a * of septic disposal area.
*
No. of bathrooms to COMPLETE INFORMATION REQUIRED BELOW. •
•
Fireplace? ,ups Wood stove? ,cd9 * Size of property /20 ft X 1PCD ft.
Foundation style and size: * Existing building(s) Size ft X ft.
,ib/1F
Piers- No.of Size- ft x ft. *
Existing building(s) Use �.-9
Depth below grade {rli • f•t; *
* Proposed building, distance from property line
FOUNDATION _ Footing sized " X' 7v lax *
d e Front yard ft Rear yard ft
wall material * 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.
0 * PRIt1ARY BUILDING -
* * * * * * * * * * * * * * * * * * * * * One family dwelling
* Two family dwelling
Proposed date of placement / / * Multiple dwelling / Number of units
Aarox. Value._ of Home_ $ ��asc; a Permanent occupancy _
/ * Transient occupancy
Water supply - Well Municipal V ,. Business
• • Industrial
Septic Permit required? yeC S * Other
• If addition, what will use be?
FURTHER INFORMATION REQUESTED
* ACCESSORY BUILDING-
ON THE REVERSE SIDE OF THIS SHEET.* Detached garage/one car/ two car/ car
* Attached garage/one car/ two car/-car
* Private storage building
* Other
Form MIIP 5/86 and-vl
•
APPLICATION FOR MOBILE HOME PERMIT, (CONTINUED)
State of New York Division of Rousing and Community Renewal
INSIGNIA OF APNIOVAL OF THE STATE BUILDING CODE
1 . INSIGNIA SERIAL NUMBER 0/4 5 Y
2 . NAME OF MANUFACTURER S�7 (
3 . PLAN APPROVAL NUMBER
4 . MODEL OR COMPONENT DESIGNATION ._j/9 >•=
•
5 . MANUFACTURER'S SERIAL NUMBER (J� / / ZS 7
6. DATE OF MANUFACTURE / - 23_ - „•., .,; —
•
•
•
AZ.Z 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.
# * * * h * * 4 * * * k 4 * 4 .* * h 4 •* * A * * 4 4 * 4 4 * * 4 * ** * *
Town of Queensbury 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.
Signature__ zAd e• L�
Owner, owner's agent, rcnitect,contractor
•
a * * * * * •a a * a * * * * * a * a a • a a a a a a * a * a * * * * * '* a * * a * * * * * 'a
SPECIAL CONDITIONS OF THE PERMIT:
•
•
•
•
•
• • , By
.
. • .
.
4:111_ TOWN OF QUEENSBURY
4/ j APPLICATION FOR SEPTIC DISPOSAL PERMIT
OWN
DATE: / /` 9 /9�o
LOCATION OF PROPERTY FOR INSTALLATION ,ri _Tsy,A00-Is ,wesi.ygo
Owner's Name: tbonc1J / S',c
Address: /� ,yo���-;�,y� c(46
Installer' s Name: r • - S C�ns��uc���,7 Telephone: Srf7•- /C2c/
Number of bedrooms (residential only) .5
Total daily flow (compute @ 150 gal per bedroom) YS?Y
Topography: Circle one: fla Rolling Steep. Slope % of Slope
Soil Nature: Circle one: and Loam Clay Other /Depth:
Ground Water: At what depth? ti/P Feet
Bedrock or Impervious Material : At what depth? N i9 Feet
Percolation test: Circle one: not required required
Rate - /Uf! Min. Per Inch
Domestic water supply: Circle one: ici ai Well Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank /oo o gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench 'a feet/Total system length /OP 7 feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used if /Depth or Thickness feet
*****************************
HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alan! system and associated electrical work to be inspected by an approved
agency.
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: irof,‘,/,/„A" . DATE:
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 co 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 co structures
4.) location and distance to any water supply
5.) size and dimensions of all tanks, distribution boxes,
tile fields and/or drywalls
B. No system shall be covered before inspection and approval by the
Building Inspector: Failure to comply with this requirement may
rQsult 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 co produce said plot plan at .time of inspection may •
-
resulc in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa—
tion, alteration or repair of an approved system, a new proposal must
be submitted to the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES. DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
•
•
k,Ini rks:
0,t'() tcyzioLeic
w 'o TOWN OF QUEENSBURY
�� Bay at Haviland Road, Queensbury,NY 12804-9725-518-792-5832
Building & Codes Department
INSPECTOR'S REPORT
4,-(7, 9 19 9(
1 c)IC^ 15 LA Ain A-L
PROPERTY LOCATION
N
OWNER OR TENANT
BUILDING SEWAGE SIGN OTHER
REMARKS
�I t ) zi(0( I (fSl Fc I ri - 0
IVY'/TIA-t t)A�--fs
1
d .
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CONTACT THIS OFFICE Vv A4 1)LZ. rti9
st
INSP CT
"HOME OF NATURAL BEAUTY...A GOOD PLACE TO LIVE"
SETTLED 1763
mmr\
•
TOWN OF QUEENSBURY
531
QUEENSBURY,BAY NEWROAD YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION / o,
REQUEST FOR INSPECTION
RECEIVED rJ/,5/ l
NAB act l C� r
LOCATION C1\1 1 e_ LS) rveQ R1Pe-,
DATE si I Q r c' ( • PERMITI l O —� I
TYPE OF STRUCTURE Q� )-6)(1 Q
� }l e-
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING FINAL ELECTRICAL✓SEPTIC
INSULATION y WOZUSTOVE/FIREPkkCE
SITIE P /VARIANCE REQUIREMENTS YES _ NO
L-leC`� ccinaQ
REMARKS
if
APPROVAL
N/ YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION \ J
PLUMBING VENT f
--ROOFING- - - ----v - - -
SIDING A I
DECK/PORCH/STEPS/RAILINGS )<,
RELIEF VALVESx
FURNACE/HOT WATER OPERAT�ING
BASEMENT INSULATION/DUCr1 ORK
INTERIOR TRIM/PRIVACY D0 S I
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPAEU A
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
HANDICAPPED ACCESS
SMOKE DETECTORS Ste;'36.-toy i \.
BATHROOM FANS/WHOLEHOUSE FANS ',
ALL PLUMBING .FIXTURES OPERATING
GARAGE FIRE PROOFING1I
DOOR CLOSERS
OTHER FIRE SEPARATION v;
FIRE/DEMISE WALLS
DUMPSTER
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C
COMMENTS:514 tar I. ,G 1U5TA-cCLlo
CUc�fi,v �o D1 Cs
IAALL Noy 9 2 - 574o `rT re_
ARRIVE ;C (:'.
DEPART (1 32 Co
ELECTRICAL INSPECTIONS
DUPLICATE MUNICIPAL RECORD
Permit No.
` a g e
Owner "
Occupant p
Location /�Ale.j i ;s #1N-19
/C n V Street
Town or City State
Installation as itemized on reverse side has been visually inspected pursuant to applicable
codes.
Installed by \T O#41 `'P,L
Date 0.0aLeWeI7).ft‘ele14—gaspeztor
MIDDLE DEPARTMENT INSPECTION AGENCY,INC.
FORM NO.18 EL. 1337 West Chester Pike,West Chester,PA 19380
ROUGH WIRING OUTLETS H.P.AIR CONDITIONER
OUTLETS WIRING &CONTROLS FOR BURNER
RECEPTACLES H.P.PUMP
FIXTURES K.W.OVEN
,41, 0AMP.SERVICE EQUIPMENT H.P.GARBAGE DISPOSAL UNIT
K.W.MP.SERVICE CONDUCTORS K.W. DISHWASHER
K SURFACE UNIT K.W. DRYER
K.W.RANGE AMP. RECEPTACLE
K.W.WATER HEATER FRAC. H.P.VENT FANS
41b /3/Cc A 'i2C 5'E721/fe— oA/G
MOTORS H.P. 1/20 1/12 I/10 % I/s ''/ '/3 %: '3A 1 1' 2 3 5 71/2 10 15 20 25 30 40 50 75 100
MARK NUMBER
OF EACH SIZE
APPARATUS
ncite,v_cn
Down o1 ( ueenibur,) pi
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
(
NAME �C�Y\ !71Nr)�/Ge-Q •
LOCATION 'Nth(')(' 71/. • •
DATE ( // PERMIT NO. 6 ()
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length 00 /+
Length of each trench 5 0 1 y-'
Depth of trenches 3;_fT •
Size of gravel '? _
SEEPAGE PITS*Nuinbero
Size- ft —X }ft.
Gra size
PIPING: f Size Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES `, NO Partial
11
LOCATION/SEPARATIONS: .!
Foundation to tank ;\ !v ft.
Foundation to absorption Zp)f t.--
Absorption to lot line \ ' 3 ft--
Separation of pits / ft.
LOCATION OF SYST l PROPE TY(circle one)
Front - ear Lefit sid -, Right side -
COMM TS:
P (Pil 540(Al Al(
-c CI A-C L '' 0 U(0. t° NCB
1 •
SYSTEM USE APPROVED Y NO
•
Building In pector
•
01/86 and vl
Zg-Ay-
TOWN OF QUEENSBURY (IdATf\
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED ,5"/ /1�' J 6
,\
NAME J r (n-NG ad)
LOCATION (-1,:t) �/
DATE �j/ 1/C/i PERMIT # 9 0 -- (P
TYPE OF STRUCTURE V�jC?
, C )-/ -
RECHECK APPROVED
, N/A YES _NO
3 F02ILNGS_"/_P_I-ERS= ' I/
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLLOWING
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE .ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING 'i
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING: '!
JACK STUDS/HEADERS
BRACING/BRIDGING ;i /
JOIST HANGERS
JACK POSTS/MAIN BEAM ;i
•HEATING ROUGH-IN ;
INSULATION: f'
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS �` R-
WALLS 1 R-
CEILING F. R-
DUCT WORK OR PIPING I?N UNHEATED
SPACES s
REMARKS:
ARRIVE p/6-
DEPART
INSPECTOR
•
I UWlN1 OF Qt, ^ j° t.11 1f
• OCT - 21990
BLDG. & CODE, DEPT.
•
•
•
•
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12, BEDROOM BEDROOM R it " 11
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