1989-899 CERTIFICATE OF C►CCUPA►.NCY
TOWN OF QUEENSSURY
WARREN COUNTY' . NEW YORK
Date t9
1, ' Y ttr `tTiat work requested to be done as &hnwn by Permit No. 89-899
has been ,completed.
'x1.is structure may be occupied as a '� .
Rhode Island & South Aves .
C Kvner
EW C*der 'Town Board
Tov4N OF QUEEr4SBURY
Director of HIdg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEE'NSBURY �
No. _ s9-s99
WARREN COUNTY, NEW YORK o
PERMISSION is hereby granted to ARTHIiR & CDLLEEN JDHNSDN
OWNER of property located at Rhode Island &South Ave so Street, Road or Ave.
in the Town of Queensbury, To Construct or place a I to i 1 H
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.
t . OWNER'S Address is
Box 238 - Connecticut Ave .
Glens Falls
2. CONTRACTOR or SUILOER'S blame S
x
Rainbow Homes
V
3. CONTRACTOR or SUILDER'S Address
Route 9 - Gansevoort , NY
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4. ARCHITECT'S Name a
Ct
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rARCHITEG'T'S Addressstruction — (Please indicate by XI
Wood Frame i 1 Masonry C ) Steel �r*'1Specifications Lnt14 14 ' x 56 ' mobile home as per application , specifications
and plot plan . t=
$_ Proposed use
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Mobile Home ^
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$ 48 OO _ PERMIT FEE PAID — THIS PERMIT EXPIRES November�6 �g to
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Gueensbury before the expiration date.)
Dated at the Town of Queensbury this a6th Day of — .
lc
n.n
? for the Town of Queensbury rn
SIGNED BY
g.ui and Zoning I ctor 0
3C
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TO 13E COMPLETED BY I)LOO V DEPTO
■■ Application No.
uwrrr ose fens6urt Permit Issued 19
LDING
d ZONING DEPARTMENT
Gay and Hav le ni it Expires 19 land Road, R.D. 1 Box 9r9 Zoning Designation T��N RACE
Oueensbury, New York 12801 Variance No..
Site Plan Review No .
APPLICATION FOR Apl� ov y
MOBILE HOME $�Q Gop� DEQT.
PUILDING 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
Le done in accordance with the description, plans and specifications submitted , and such
special conditions as may be indicated on the hermit .
The owner of this property is :
P . U. Address b 7s 3 C � r✓ �✓ Z. e` a s J L L S : Tel . s' - 7 70
Property Locations '-:w Cok' +u,-- ,Q ra Tax Map No . �
Street i :umber or building lot nuW;aer
Subdivision name (if applicable? ""ter
TllE !PERSSC7i RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS z
1 fib !/l'd? a /4'- � • cJ P 6 At 4Zo,X .7.3 r.Y 1�' tleec_� 6:- Lr E-=elzIs
Flame P 0. Address Tel . NQ r �+
Namu% of InstallerA/446v� r Address 4Z U& Tel .
Name of plumber Address Tel . AmAincW
Name of mason Address Tel
MOBILE HOME INFORMATION : * ZONING INFORMATION :
New Home Placement * A PLOTPLAN WIUST HE PREPARED AND SUBldiTTED ,
drawn reasonably to scale and attached heareto ,
Replacing existing Home * showing clearly and distinctly all buildings ,
Size of new Home ft x�t * whether existing or proposed and indicate all
* set-back dimensions from property lines . Give
Single w ` le Double wide * street and number or lot number and indicate
No . of rooms ( excluding baths ) o " whether interior or corner lot . Show location
* of water supply and location and configuration
No . of bedrooms, * of septic disposal area .
if No . of bathrooms ,�, CO!lFLETE INI"rORMATION REQUIRED HEL.OW .
Fireplace?wood stove? &92 Size of property - ft x-ft .
Foundation style and size • Existing building ( s ) Size --�� ft x ft .
Piers- No . of � � X ft * * Existing building(u) Use
* .�
Depth below grade ft .
* pro-posed building , diz}i.an4e from property line
FOUNDATION - Footing size X W .
* Front yard ft Rear yard t
Wall material * Side yards ft and
Wall thickness "" Height ft. * If on corner , souback from side streetf t
t
Total depth below grade "!'"R ft . OCCUPANCY INFORMATION
Grade to Home floor level - ft . • PRIMARY BUILDING,
« : w * yr • * w x w r w w t w * fr ♦ * w +► One family dwelling
family dwelling
Proposed date of of placement- / /�/ ow� ultiple dwelling / Number of units
Aprox . Value. Home $ ael `l ' AM Permanent occupancy
—...--�* .Cransient occupancy
Water supply - Well Municipal y * *+ �usiness
„ �ndustriai
Septic Permit required?� "► - t3thsr
if addition* what will use be:
* 4004407, C
' URTHER. INFORMATION REQUESTED * ACrrZSSORY BUILDING-
THE REVERSE SIDE OF THIS SHEET * * j4W Detached garage/one car/ two car/�� car
* ,Attached garage/one car/ two C r/ _car
Private stgrrya building ���7
* --- her �-
•
5 / B6 md3 vl
APPLICATION FOR MOBILE HOME PERMIT,* ( CONTINUED)
state of New York 'Division of Housing and Community Renewal
INSIGNIA OF APPhOVA L OF THE STATE BUILDING CODE
I . INSIGNIA SERIAL NUMBER
2e NAME OF MANUFACTURER op
3 . PLAN APPROVAL NUMBER
4 . MODEL OR COMPONENT DESIGNATION .—
5 . MANUFACTURER ' S SERIAL NUMBER "
5 . DATE OF MANUFACTUREewel
AZZ the above ireforr►�atmon is to be
should be a found on a plate or R esker tuhieh ffi.xed to the Mobile Home . Complete _above with that @nformattic7n ,
Town of Queensbury
County of Warren A F F I D A V , I T STATE of NEW YORK
I swear that to the best of my knowledge and belief the statements Gpntained
in this application, together with the plans and specifications aubaitted , are a trove and
complete statement of all proposed work to be done an the describe
provisions of 8[JTLl3ING CODE . {E ZiONItJG d premises ,eared that all
the proposed work
ORDINANCE , and all other laws pertaining to
shall be complied ,a
with, pacified or not, and that such work is
authorized by the owner.
Signature -?
Owner* owner ' s ag ' t, arcnirect, contractor
SPECIAL CONDITIONS OF THE PERMIT :
me
APPRO
APPLICATION FOR SEPTIC DISPOSAL PERMIT 3pNIMt3 � �,� (;�l�l ' WL
WMOF �
DATE /
LOCATION OF PROPERTY FOR i�LLATION
- 3 Ica
owner's Name : -c..�.r.�t�' � ��.--�'�-"" Telephone: 3
.� ��.7& d
Address: t'' /``�' f
Installer's Name: Telephone:
Number of bedrooms (residential only) _
Total daily flow (compute CcD 150 gal per bedroom)
Topography: circle one: FIa Rolling Steep Slope 9b of slope _
Soil Nature: circle onew Sand Loam Clay Other / Depth: feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? feet
Percolation test: circle one: not requ--i��r-�e----d required / rate min. inch. 4
Domestic water supply: circle one Municipal Well Other _
IF domestic water supply is a Well.
Separation: Watersupply from Septic absorption —. feet
PROPOSED SYSTEM : Septic Tank 00G? gal. (minimum size: 1 ,000 gal.)
'PILE FIELD : Each Trench feet / Total system length feet
SEEPAGE. PIT(S) : Number of _�/ _ / Size each _ _ feet by ZO feet
Size of stone to be used / Depth or Thickness _ � feat
# � 7
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.
Co 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 Ordinance.
Signature of responsible person; .� � r 'Z YJ/' yx c �r^✓�
.Date:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York I280 1
(518) 792-5832
Kp 1 - i1or " { � Lll' ' T ' A C00n
TOMN OF AND
COVES
DE
BUILDING AND CODES DEPpyRTMENT
�, �, NAVILAND ROADS13A 32804"
Q'UEENSBURY , NEw' yORK
TELEPHONE ( 518 ) 792-5832
WIIX)ING INSPECTOR' S REPORT
REQUEST FOR. INSPECxTION RECEIVE
NAME �. p
LOCATION pER1y2'Z`
DATE
L� APPROVED
YES NO
i
FOOTINGIPIERS 1co S
MONOLITHIC POU
7I
GARAGE FXREP}�OOFINGC -
DOOR CLOSER ( 5) �--
SMOKE DETEC S I NSPEC�ION .
FINAL gLECTRX OF CON.STRUCTXON
_FINAL AppROV
oy TC1 7 SSC3E /0 OltC/C
PANCY 5T BE T BEFORE
TXFICATE OF OCCU
A SIGNED GE ING DEFAR'I'M
OBTAINED FR M THE B OC PIED !
THESE PREMI ES ARE
REMARKS .
S7EPAR INSPECTOR
: 1
TOWN OF QUEENSRURY
Zoning Administrator
Date!
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