1989-952 CERTIFICATE C.JF OCCUPANCY
TOWN OF QUEENSSURY
WARREN COUNTY, NEW YORK
l
Date December 11 lq $
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ILI - -- ,
' This is to certify that work requested to be done as shown by Permit NO* $ - 9 5 L --
has been completed.
k This structure may be occupied so a Mnb i l p Home
mom.
e r Road
i
Owner Eorpst Park Mobile Home Cgurt
BY Carder Town Board
TOWN OF QUEENSBURY
I { r r
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I
Building & Zoning inapectar
S
F
BUILDING PERMIT � e
TOWN OF +QUEENSBURY
No. o
WARREN COUNTY, NEW YORK • •
fs
PERMISSION is hereby granted to Forest Park Mobile Home Court `I
t-•
OWNER of property located at Lot #25 - P ' cher Road Street. Road or Ave. 1
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.
1 . OWNER'S Address is
134 Pitcher Road
Queensbury # NY o
rrl
2_ CONTRACTOR or BUILDER'S Name "l
Today ' s Modern
PIC
3. CONTRACTOR or BUILDER'S Address
54 Route 9
Gansevoort , NY
4. ARCHITECT'S Name now
rah
rn
' O
5. ARCHITECT'S Address m
;0
is
6. TYPE of Construction — (Please indicate by X)
I I wood Frame I I Masonry i ) Steel I )
7. PLANS and Specifications
No. 14 ' X 52 ' mobile home as per application
vo
8. Proposed Use '�
Mobile Home
$ 1700 PERMIT FEE PAID — THIS PERMIT EXPIRES December 6 19_9_0
(if a longer period is required an application for an extension musk be made to the Building and Zoning inspector of the
town of Queensbury before the expiration dada.)
Dated at the Town of Queensbury this Lth Ray of December 19_aq—.-
� _SIGNED BY for the Town of O.ueensbury
Building 14ing 41ctor
TO BE COMPLETED ay nLCiG. DEPT.
k C') / ,�rry Application No. - - � � TOWN OF QUEENSBURY
rliW�J �� �uPataJiG► RECEIVED
suuad 1e71
aUILDING anes ,ZOt44NG DEPARTMeNT Permit Permit Is sued 13
aay ana Hawilana Road, n.A, 1 Box 4$ Zoning oekjigni;stion
Gueenyburyr New York 12801 Vartrad
H , • DEC 4 1989
Sit view No .
APPLICATION FOR Ap y 1 L 9 $s CODE DEPT.
MOBILE HOME
PUILDING AND ZONING PERMIT a �
♦ • • r • i► • • t r ♦ w • • • w w w • • x r • wr • w • 0 w w 0 • r r 0 %W w • :: V
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTIONo ANSWER ALL OF THE FOLLOWING.
The: undersigned hereby applies for a Building Permit to do the following work which will
Las done in accordance with the description . plans and spucificationea ssubissittud, and - such
3aJ)aciui conditions ass way be .indicated on than Permit .
TFk owner of this property is : ■ u12 J'r ?!E/j1��
Jaddrasus Tel �'��/�yv
Property Locations d!! 7C //6!"�, J2C7r" Jd� 60;PW ,- Tax Map
atruc:t i,umbur or building lot nuauber
,uLdivision name (if applicable) X—�-Zgee 4:5TS �;Pw
Tlit PL:ItSON RESPONSIELL FOR SUPLRVISION OF WORK AS RECJLRDS UUII.DTNG CODES IS s W4
IJA:na P. O. Adair ea aa /'2H3 Tul No
Name Of Inutallex_�l1.ag� f . 7✓7d /�llddreas�� �T �, ,�sf /{��'✓Jr�rf+���I�/7`cl . ��g /y •3~' �-
N.auw us ,E+ltsnwl�u:r Jtiddrewa '1"r*1 ,^ ^�
N.:iear` e]J: a�u Cann Add rCsra 'i'el .
MOD I LE HOME INFORMATION * r ZONING INrORMATION :
New [tome Placement 4�9'�� * ]► PLOT PLAN kusT ac PREPAMD' AND SUEIMI'i'f.£o ,
drawn reasonably to scale and attached hereto.
Replacing existing (tome • aehowing clearly and distinctly all buildings ,
Size Of new Home_ _ft X 5-2, £t * whether existing or praIaosed and indicate all
sat-back diwonsions frola property lineu . Give
Single w '• le _ Double wide street and nuazlaur or lot nuaud:ocr and indicate
. of rooms ( excluding laths ) � ' whuther interior or corner lot . Show locution
No .
+ of water supply and location and configuration
No . of bedrooms
of septic disposal area .
r
NO , of bathrooms r COMPLETE INFORMATION REQUIRED BELOW .
Fireplace? ./' O' Wood stove? ' Size of property ft x ft .
Foundation style an ze : ' Kxiating buildingtaE) Size ft x ft .
Pier. s- No * Of
x ft . * h::xiating building 1U ) Uxse
Depth low grade ft .
Preaposiud building , disLance from property line
P(XJNDATION -- Pooting,, ssize •� X * Front yard £t Rear yard ft
Wall material /L/ _ r Side yards tt and ft
Wall thickness �•• Height ft. . If on corner , lior1aae:k from aidsa ratresat it
Torah depth below grade ft .
" OCCUPANCY INFORMATION
Grade to Home floor level ft . . PTtXK^XV BUILDING r
• r . . . • ■ w • . r r ■ . a w w w t w r 4921 One !welly/ dwelling
WWWWWr Two faamily dwoLlinl
Proposed date of placement
, /� c�/�+� � r Multiple dwelling / Number of unites
/ 2 Aprox . Value. of Home S 9 + Qa'�""ncnt occuts.ancy
r Transi¢nt occupanesy
water supply -- well Munlcipal�� # [lusiness
Industrial
Septic 'Permit required? ,e Other
# If additlo+t , what will +ass b.:l'
•
FURTHER INFORMATION REQUESTED
ACCESSORY DUTLDXNG-
ON THE` REVERSE SIDE OF THIS SHEET . * Detached garage/one car/ two car/ ear
* Attached .garage/one car/ two car/ car
" Private storage building
" Other
Form MHP 5 / 06 md - vl
's
APPL I CAT ION FOR MOBILE HOME PERMIT,,
CCONTINUED)
State of New York 'Division of liousincj and Community Renewal
INSIGNIA OF APPhOVAL OF THE STATE BUILDING CODE
1 . INSIGNIA SERIAL NUMBER.
2 . NAME OF MANUFACTURER ., iec
3 . PLAN APPROVAL NUMBER
4 . MODEL, OR COMPONENT DESIGNATION --g fl) T.- 4V0/4e
&06 C7.c� Y�
5 . MANUFACTURER ' S , SERIAL NUMBER
fin DATE OF MANUFACTURE ' / c3
AZl the above i. nf6rmation ie to ba � found on a plate or atzckex• which
thou ld be affixed to the Mobile Home . CcMPUte .above r)i.th that infoxmation.
♦. +t �! A A • 'A �/ ' A - A A A A A A A A A +f A A A A A A
Tonal of Que@i+sbury
County of warran A F F I D A V . I T STATE OF NEW xORK
Y swear that to the best in as
of m knowledge and belief the statements contained
+tomplcte statement t of all Chit the plans and spcificat3.ons Submitted , are a true and
+. nr together withmy �eproPosed work to be done on the described premiace and that all
proviaians of the BUILDING CGOU , THE ZONIMG O,ROXNANCS, and all other laws pertaining to
LhO proriosed work ,sha11 be complied with, r+tlethar authorized by 'the owner. ucificd or not, and that such work is
`
SigRatune
n@ ow" ' S agent . arc &cect , con a for
r + r • r w t r r • w w * w w r w w w w , w w w w w w w w w ,e w w w w w ' w w w w w r w w r w - w
SPECIAL CONDITIONS OF THE PERMITr
"
r . .
TOWN OF QUE'ENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, 5 W) Yopy 9� 5 28"
TELEPHONE (
32
BUILDING INSPECTOR' S REPORT
REQUEST JOR INSP CTION RECEIVED? _ _�-----
e
NAME
.LOCATION
D f II PERMIT #
ATE I"s
APPROVED
YES NO
FOOTX NGI PI ERS
MONOLITHIC POUR FORM
FOUNDATION/DAMP-PROOF G
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
�F FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING G
SIDING Z,
EXTERNAL PORCHES/STEP
STAIRS-CLEARANCE & ILS
PLUMBING FIXTURES/R LIEF VALVE
INTERIOR TRIMJPRIV CY DOORS
FINISHED FLOORS
GARAGE FIREPROOF G
DOOR CLOSERS)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTION
FINAL AP P OVAL CON' TRUCTION -
A SIGNED ERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFOR
THESE PREMISES ARE OCCUPIED!
REMARKS :
INSPECTOR
THE NEW YORK BARD OF FIRE UNDERWRITERS
. . , BUREAU OF ELECTRICITY T-
41 STATE STREET, ALBANY, NEW YORK 12207
,Date i I . 4 Application -No,
,00n f�ile..�y
THIS CERTIFIES THAT
only the electrical equipment as described below and introsbaced by the applicaast nasasd on she above appdicaatson .umber Ira the prenaieea of
FioiQi7t @q+i^11L Mti.!►. Pi11 �' + ihl"
era thefollonoinig location; +Buweppra rcne LJ 1st Ft. 2ntd FT. oar Section
Block Lot
acos examined on SIL t,.zhI ��Ws and found to be in corraplio"e with the requirements of this Board.
MIXTURE FIXTURIS RANGES gOtLKIPl4 DECKS OPENS DISH WASHERS El[HAU57 FANS
llTACIES SWITCHES
OUTLETS INGA.MGtSCEWT FFLUI OTHER
DRYERS FURNACE MOTORS FUTURE AFFUANCE FEEDERS SPECIAL RECFT TUNE CIOCKS RgI UNIT HEATERS MULTI 47LlTLET W/AMERS
- SYSTEMIS AAaT wwms
AAI K. W. di H, r. GAS H. P, AAAT. wo- �- w. G. AAar. AAAr. AM7- wears. TRANS- AMT. H. r. Hd. Of FEEL
SERVICE DISOCIN iEct HO. DF S E R V I C E
AMT. AAAR. TV" Mi<T� 1 .e' 2W a Ar 9ry 2 aI 3W 9/t 4W �' aRER NCOND. d GC CC�D, NO, CrF MI.LEG ���,� NO. Of NEUTRILS OF'HWy`"A.L
411k IF
■ �LaGF `T"V F
OTHER APPARAI
$4 R*)r t BRANCH MANA43E9
Per. 3
This certificate must not be altered in any manners return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNf: R_
THE NEW YORK BOARD OF FIRE UNDERWRITERS CERTIFICATE NO.
DO NOT WRITE HERE - FOR OFFICE USE ONLY
BUILDING PERMIT NO
TEMP h DATE
i
CRY OR VIL
TOWNSHIP GOUNTY
'STREET AND NO OR Ri2Cp '
POLE NUMBER
BEr ,�„�r� .
W'EE Wi{M l'uH]OROSS STREETS IS PREMISES LOC.4Tf0? SECTIQN BLOCK LOT
OCCUPANT NAME -,
BUIL DING OCCUPANCY
OWNER S NAME AND ADDRESS
HOME TE LE P.IOk.IE NUMBER
d+ /y
�� " / I"'^-/�'f�'1r/S _ f: /-'''f'�fr.. l /_S'•1� s.-/_ f , -
CURRENT SUPPLIED W FROM THEIR ---'-
OFFICE WORK TELEPRONF NUMBS/y/ ' '
BUILDING IS
OLD '_ WORK IS NE ADDrTIONAL 1-I DEFECTS REMOVED n
_ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS No. o1 Fixtures & BRANCH OFFICE USE
Lion Lamp Receptacles MOTORS HEATERS CIRCUITS ONLY
IDR Side Atlach'I
Ceiling Wail ReceP'ts Switch Pen"( Bracket No Type Each No. Each No GI&uuge INSPECTION
OUT-
SIOE _
SUB-
BASE
EASE- --
MENT
1$t ._ . ..
FL
2nd
FL,
3rtl
FL.
REMARKS' UST OTHER ELECTRICAL DEVICES NOT SET FORTH ABQVE.
THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED, BUT IF AT TIME OF INSPECTION, THERE IS
FOUND ADDITIONAL ECUIPMENT NOT ABOVE LISTED, YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER
THE ADDITIONAL EQUIPMENT, AS PROVIDED BY THE APPLICANT
512E OF MAINS FEEDERS ELECTRIC, SIGNS,'LAMP,%
' 1[T'AL LW�Tf^,y
CHAA/JA�el'1�'E R.OF�jWe]RK ,f}'_ l/1 ,/�' E%P+OSED GAS TUBE SIC u RAN SFORMERS OF yA
Y y F/ C / /�[/ lr 1. JF"'x�� + j C- U CONCEALED
DATE WgRk RE Rrl 1.. ` /Jg TE COMPLETED SIZE OF SIGN(NUMBER) Cpp lTy.�
s 1744 �
SERVICE ENTERS BUILDING MANUFACTURER OF SIGN
I. OVERHEAD UNDERGROUND
DATE INSPECTION REOUESTED ON [OR AS NEAR AS PGSSIBL EI v MUST ENITER APPLICANTS /
1. L.rf f C L. .F''Ij CC✓/ t r N1ENTiFlCATION NUMBER '�"' I y !1 z 1 L7 �.s E (re"!, l y
AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
PRINT NAME AND ADDRESS
NAME qPPyPL�ICANT r DATE OF APPLICATION TLlpIE OF T
STREET Ab7ESS _ i �� �L~. TELL f NO
Ie
CITY OFIPOST OFFIC//F"`�F LICENSE NO. /WHEN APPLICABLE
85 John Street
41 State
L� 2 Arterial Road
NEW YORK4 NY 10036 L � ALBANY,Street NY 12207 BUFF Avenue ALO, NY142D2 ❑ R,OCHESTER, NY T4608 7 Lake Avenue E SYRACUSE, NY 13206
THE IV W 1YC?F K BOARD OF FIR
_a UNDERWRITERS
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