1989-872 CERTIFICATE OF OCCUPANCY
TOWN OF +QUEENSSURY
WARREN COUNTY, NEW YORK
i i]ate [December ,20 1983�
This is to certify that work requested to be done as shown by Permit No, 89-872
has been completed.
This structure may be occu�ned as a - mobile home
ationtr^C�#�@—� L u z e me Ro a d
Owner Northwinds . Inc
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code En f meet
.. BUILDING PERMIT
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TOWN OF QUEENSBURY No 894k72
WARREN COUNTY, NEW YORK a
PERMISSION is hereby granted to NORTHWINDS , INC
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OWNER of property located at Luzerne Road - Lot #30 Street, Road or Ave. ry
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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
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
t . OWNER s Addressis
PO Box 224
Glens Falls , NY o
2. CONTRACTOR or BUILDER'S Name
S
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TODAY ' S MODERN a
3_ CONTRACTOR or BUILDER "SAddress M
C7
54 - Route 9
NY
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by X)
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I Wood Frame I I Masonry ( } Steel ; I
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7. PLANS and Specifications
No. 14 ' x 66 ' mobile home as per application and plot plan . v
S. Proposed Use
Mobile Home .
$ 29 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June I
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
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town of Queensbury before the expiration date.) rri
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Dated at the Town of Queensbury this 3rd Day of November
SIGNED BY for the Town of Queensbury
Building and Zon�riQ Inspector
BE COMPLETED BY nLOC . DEPTa
JOwrl O uPrrr3l. rrr i Application Now c •C
BUILDING rna ZON1 VG DEPARTMENT Plurwit Isuued
BaY Una Hariland load, R.C]. 1 Box ()Q Perts:� t ExPireca l'l , —:QW OF QUEENSBURY
Ouuensbury. New York 12801 Zoning ofa:aign.�tion RECEIVED
VarianCd No.•
site Plan Reviuw No .
APPLICATION FOR Approved : Q '. � �g9
MOBILE HOME D CODE DEPT.
PUILUING AND ZONING PERMIT
+► w w w w se w • w w w M w ar +r - r ,:► w • w w ♦ r r w w r r' w tr w r w w ar �e w w :: r
A PERMIT MUST BE OBTAINED W- FORE BEGINNING CCNSTRUCTIOtV . ANSWCR ALL OF THE FOLLOWING .
Thou undcraignud hereby applies for a Building Permit to do the following work which will
L+u dune ie► accordancu with tha description , plans and spueificationra esubmittud , and - 4such
s�teci:.l cond'"onu as uksy be indicated on the Permit ,
'11W owner of this property is : / 49/?z Arwl/,,� z, a
P . G. Ad lreus_ Q. D }C � � ' p
��-- s_itJ' `� Teal .
Property L.ocationr G. r �Zel/Z..JE ' /2e9i'4G7 r'_/?�'-#
� Tax Map fla .��/
Strout s.un�cr or kiw"-aing lot nuutbur
Sul+dlvision Hama (if applicable) V W A0110J.S
1'11L YLit:pN RESPONSIBLE FOR 511PERVISZON OF WORK AS FADS UUILDINC CODES IS :
M00451ZAt moos nl040 ) �f - �' � .4.Us �lJGdp27 rtlY IZA31 79� 1e�.3Z finan4 F'. O. Addresu Tol . No .
Nam4 of In;: ta] ler .$ 1}w1E Address
N.atue: ul` ,�,lunebur � Tel .
u nddrwuea Tul .
Nate., t ua,.suon Addrs;nu
MOBILE HOME INFORMATION : w ZONING 1NFORMATICNV
New 110r4e Placement _ e,E.S _ A. PLOT PLAN ;iUST Be PREPARED AND SUBMIRTEDA
Replacing Pxi t +. ng !lass► ^ ,.1JG? T drawn raaso^ably to "c^lo and attached hurcto,
"howing clearly and distinctly all tuildings ,
maize of new Itorne ft X,�ft whether wxisting or proposud and Lndicato all
* sot-back dimensions from property linaue Give Single w ' 4e Double wide
streeat and nunibur or lot nuuLbur aril indicato
No * of rooms ( excluding baths ) C * wbuth0v interior or corner lot . Show location
No , of bedrooms w of water supply and location and configuration
� / of septic disposal ara" .
No * of bathrooms
z3 ,�
w COKPLETE INFORMATION REQUIRED DELOW .
Fireplace? 4/49Wood stove? �a ' Size of ert
ro
P p y ;L ft X 169 C .
Foundation style and - size : i xiatirtg building ( u) Size ft X ft .
Pier. s-- No . of Size:- ft x ft . • L xiating building ( u ) ue;e
Depth below grade ft. w
" kropouud building , diULanUo trota property lino
FOUNDATION _ Footing size " X "
,. Front yardG" S ft Rear yard 0 ft
Wall material „ Sida yurde �1 ft and / ft
Wall thickness Height ft. + If on corner , aaclaacX froau 610A0 eicruut fc
Total depth below grade ft . ` OCCUPANCY INFORMATICN
Grade to Home floor level ft. w Y' RY IlUSLDING
• w w w • r ar w w w w w w w • w s +r R One family drrsxlling
,t/ „ Two frtnily dwelling
Proposed date of placement /I J / ! w Kultlplu dwelling / Numbeer of units
Aprox . Value. of Home S C? C � w >Perm:inertit occulaancy
'transient occupancy
Water supply - well Municipal_ * I3uyinuas
„ Industrial
Septic Permit required? Ctthur
Ajmda4k/ d,,L -F 1 ,ti t.y - w If additiosto wle:,at will uss Liwl
FURTHER INFORMATION REQUESTED •
w ACCESSORY BUILDINC:
ON THE REVERSE SIDE OF THIS SHEET . • Dotached garage/one car/ two car/ car
Attached garage/one car/ two car/ car
rrivato storage building
A ' :)LOthe r X _ W�l/ 1 6
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Form M11P 5 / aG ma - vl
APPLICATION FOR MOBILE HOME PERMIT, CCONTINUED)
State of Now York Division Of Housing and Community Renewal
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
/ 9 9a t� ca a .z,�G , -- y -per 7
I . INSIGNIA SERIAL NUMBER
2 e NAME OF MANUFACTURER
3 . PLAN APPROVAL NUMBER
4 . MODEL OR COMPONENT DESIGNATION
5 . MANUFACTURER ' S , SERIAL NUMBER +
6 . DATE O!+ "MANUFAC 'TURE
AZt the •, above information is to be found on a pZate or aticker which s ahou ld be affixed to tho Mobile flame . Comp late , .above L. Ith tftat snformatzon,
♦ 4A • w w # +! w w # +1 a # +F A ` w # •A +r rt a ♦ A ♦ A A # # ` A A A ; +! # # #
Town of Queenabury dry
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 contained
in this application * togethor with the plans and specifications submitted , are eY true and
eorrRf "O scateencinc bE all proposed work to be done on the described Promises and that all
provisions of the BUILDING CODED THE ZONXNG ORDXNANCE, and all other laws pertaining to
the proposed work shall be complied with, whother pucified or not , and that such work is
authorizod by the owner.
Sig ` _ _ �,//��
nature ._ - - - _,k':.:�.'GC'S .,
wn " s agen ; r nitect , retractor
,► • w w f w � • • r * ♦ w * w • w w w y , N � • rlr f w w s • w r w t r w r w w 4 w w rr • w w ' y
SPECIAL CONDITIONS OF THE PERMIT =
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TOWN OF QUEENSBURY pA
BUILDING AND CODES DEPARTMENT
BA,y & HAV X LAND ROADS
QUEENSBURY, NEW YORK I280k !' � lL13
TELEPHONE (518 ) 792-5832
BUILDING IN ECTOR' S REPORT
t
REVUEST FOR., ,X NSPECTIO RECEIVED ��
NAMEC.,'C - C� C�S R---
LOCATION ` ` ck P
IT #
DATE c /
APPROVED
YES NO
FOOTINGIPIERS
MONOLITHIC POUR FORMS_ — --
FOUNDATIONfDAMP-PROOFING- .� -
BACKFILI. APPROVAL
r
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
&,4°/rINAL INSPECTION: elm
CHIMNEY HEIGHT { l'
ROOFING
SIDING /
EXTERNAL PORCHESI EPS
STAIRS-CLEARANCE FAILS
PLUMBING FIXTURE /RELIEF. VA VE�
INTERIOR TRIM/P VACY DOORS
FINISHED FLOORS
GARAGE FIREPR ING
DOOR CLOSER {S)
SMOKE DETECTO
FINAL ELECTRICA IN C ITEP ON
FINAL APPROVAL F CONSTRUCTIONS --
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A .SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS
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INSPECTOR
EGERTIFIGATE NO.
THE NEW YCORK BOARD OF FIRE UNDERWRITERS
00 NOT WRITE HERE - FOR OFFICE USE ONLY
i PERMIT NODATE
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TEMP 0Jy g f
/ COUNTY
Ti"Y.Mi45HIP LIj( 1/'? /jfv/G C,r-
CITY OR V ILL/+GE r
f /�� f � ,.� /�..r''•y7 POLE LOT
NUMBER
STREET A NO OR ROAD i0s 4 c3 y -� �,.�4 �,J oj< /,r� �4 c- r c '✓
�, �L,J' BLOCK ..
00 ++'' // SECTIONBETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED'+
BUII PING OCCUPANCY
pCCUP ANT'9 NAME
[/� /l` HOME TELEPHONE NUMBER
OWNER'S NAME AND ADDRESS /'} � .\ ✓ ��, � � �/�" !� £ eA Y/
/{ /.) ;;ell I^f+�s {l OFFICE WORK i EPPHONE NUMBER
(_
.. V FROM THEIR
CURRENT SUPPIIEb
/•��/ l,,�yr'r DEFECTS REMOVED
BUILDING IS yyy{' WOftk 15 NEW U APPITIfJNAL
NEW�S.� OLD M
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
OFFICE USE
No. of Fixtures $ MOTORS HEATERS CIRCUITS ONLY
NUMBER OF OUTLETS Lam Receptacles
Loaa- p ELP No. wattsNo. GaugGe INSPECTION
tips S� All i swil Pendant elNo' TYPO Each Each
Ce+ling Wall Recep'Is
OUT-
SIDE
SUB-
BASE
BASE-
MENT
1st
FL.
2nd
FL.
3NJ
FL.
REMARKS: LIST OTHER ELECT RI GAL DEVICES NOT SET FORTH ABOVE-
Aj Ai C
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. TOTAL WATTS
FEE PERS ELECTRIC SIGHSn-xM PS
SIZE OF MAINS VA
.� EXPOSED GAS TUBE SIGNrFRANSFGRMERS OF
CHARACTER OF WORK L I CONDEALED CAPACITY
PATE COMPLETED SIZE OF SIGN (NUNISER7
DASE WORK TD BE STARTED
MANUFACT URER OF SIGN
Mal ENTERS BUILDING 0 LINDERGROUNP
:J �JERHEAO MUST ENTER APPLICANTS , la2 IQ I 6 I -7 i 0 IV
BATE INSPECTION RECI E T 4 N (OR AS NEAR AS POSSIBLE! IDENTIFfGTION NUMBER
AVOIDPill
YS BY GIVIN FU LL A ND S— RA E INFORMAT ION- A LL SPi4r 3 M BE FiLLE4 IN 4R pPPL1£AT10N MAY 9E RET RNED•
PRINT NAME AND Al �y'p�- OF AP LI ION � RE
APi
NAME OF APPLICANT ��.. —/Z] III rI
` 1 ✓eP fJ L✓ +' �.+ T'ELIEPP„H E NC7
STREET ADDRESS ��
71P�CODE LICENSE NO. WHEN APPLICABLE
CIT`I.O ST OFFICE
❑ 7 lake Ave
aS John Street ❑ 41 State Street [� 5-10 Delaware Avenue C_J 21nue 202 Arterial Road
�
NEW YORKo NY 10038 ALBANY, NY 12207 BUFFALOI NY 14202 ROCHlESTER, NY 14608 SYRACUSE, NY 13206
�< THE NEW YORiK BOARD OF FIRE UNDERWRITERS
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$ m
Luzerne Rd. `#
Phone:
Queensbury, NY 12801
792-5838 �
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