1991-022 - CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
• Date April 16 19 91
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This is to certi 4 that work requested to be done as shown by Permit No. 91-022
has been completed.
This structure may be occupied mobile home
Location 6 nt 66, HomPctpad Villas [uaPrnp Road
Owner Dan Mendl & Martin Lavin Ci r )
By Order Town Board
TOWN OF QUEENSBURY
CC./1
Director of Bldg. & Code Enforcement
L i
BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 91-022
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Dan Mendl and Martin Lavi G/(10) \.. Y6c7 )
0
OWNER of property located at #163 Homestead Village, Luzerne Rd 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.
re
1. OWNER'S Address is
03
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2. CONTRACTOR or BUILDER'S Name
Mark F. Mongeon
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3. CONTRACTOR or BUILDER'S Address sv
340 Malletts Bay Ave. '
Colchester, VT 05446-1462
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
sv
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6. TYPE of Construction—(Please indicate by X) cu
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( )Wood Frame ( ) Masonry ( )Steel ( )
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IT
7. PLANS and Specifications
CD
No. 14' x 70' Mobile Home (Single Wide) as per plot plan specifications
and application
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8. Proposed Use
Mobile Home
$ 35.00 PERMIT FEE PAID —THIS PERMIT EXPIRES January 29, 19 92
(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.)
Dated at the Town of Queensbury this 29th_ Day of , ,January 19 91
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
•
TO BE COMPLETED BY BLDG. DEPT. .
•awn of Quee,iitur , Application No.
Permit Issued 19 'M r-r7 0,1 E.ENS.E tJB
BUILDING and ZONING DEPARTMENT Permit .Expires 19-' +M.4e { / }
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation
Queensbury, New York 12801 Variance No.,---•-
Site Plan�e•-view o.
i JAN 24 1991
APPLICATION FOR -_-. .t , k •
ip'_
MOBILE HOMEr, 7 a..DG. . CODE DE T.
PUILDING AND ZONING PERMIT _ I , . I
• • * * * * * * * * * * * * * • • • • * * * * * * * * * • * * • * * * * * •::•
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 i:: accordance with the description, plans and specifications submitted, and such
special conditions as may be indicated on the Permit.
200\4C4 4- C'lY D/! Ch•
The owner of t is property is: man Mendl and Martin Lavin
P.O. Address "Homestead Village Oueensbury, NY 3- '_O( Tel. 518-792-2400
Property Location: Luzerne Road Queensbury, NY
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:
Mark F. Mongeon 340 Malletts Bay Ave. . Colchester, VT 05446-1462 1-800-346-2707.- '
flame P.O. Address Tel. No. -
Name of Installer N/A Address Tel.
Name of ;plumber N/A Address Tel.
Name of mason N/A • Address Tel.
MOBILE HOME INFORMATION: i * . ZONING INFORMATION:
New Home Placement - * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
7* drawn reasonably to scale and attached hereto,
Replacing existing Home 1989 * showing clearly and distinctly all buildings,
Size of new Home 14 ft X 70 ft . • * whether existing or proposed and indicate all
• * set-back dimensions from property lines. Give
Single w` ?e • x Double wide • * street and number or lot number and indicate
No. of rooms (excluding baths) - 5 * whether interior or corner lot. Show location
* of water supply and location and configuration
No. of bedrooms 3 *• of septic disposal area.
No. of bathrooms *
1 * COMPLETE INFORMATION REQUIRED BELOW.
Fireplace? No Wood stove? No * Size of property ft X ft.
Foundation style and size: * Existing building(s) Size ft X ft.
•
•
Piers- No.of N/A Size- ft x .ft'... . * Existing building(s) Use
•
Depth below p grade ft. •
FOUNDATION = Footing size N/A" X *•proposed building, ,distance from property line
* 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
* OCCUPANCY INFORMATION
Total depth below grade ft. *
Grade to Home floor level ft.j * PRIMARY BUILDING -
* * * * * * * * * * * * * * * * * * * * * One family dwelling
* Two family dwelling •
Proposed date of placement A: S/ A P/ e Multiple dwelling / Number of units
Aprox. Value. of •Home $ 18,000 + Permanent occupancy
* 'transient occupancy
Water supply - Well Municipal X * Business
* . Industrial
Septic Permit required? No * 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 Housing and Community Renewal
INSIGNIA OF APNIOVAL OF THE STATE BUILDING ., CODE
1 . INSIGNIA SERIAL NUMBER 07-9-880C-0254
2 . NAME OF MANUFACTURER Champion Home 'Builder. Co.
3 . PLAN APPROVAL NUMBER 07-0254
4 . MODEL OR 'COMPONENT DESIGNATION Atlantic
•
•
5 . MANUFACTURER ' S SERIAL NUMBER 07-9-880C-0254
6. DATE OF MANUFACTURE • July, 1988
•
All 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.
4 4 4 4 4 4 4 f 4 4 * 4 4 * * 4 4 4 * •* * '4 • 4 4 4 4 * 4 4 4 4 4 4 *9 * * 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 sp cified or not, and that such work is
authorized by the owner. 4Q- _ - -�,r- - ---- - - -
Signature__, "„)-
Owner, owner's agent,arcnitect,contractor
• William D. McMeekin, President
Mortgage Services, Inc.
* * * * * * * * * * * * * * * * * * * * * * * * * a a * * * * * * * * * * * * * * * * * * '*
SPECIAL CONDITIONS OF THE PERMIT:
ls ic, SepT'1G •(M. i
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•
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• , By
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°' ...,.D i A, - MIDDLE DEPARTMENT INSPECTION'AGENCY,,INC.
National Headquarters
i
1337 West Chester Pike,West Chester, PA 19380
APPLICANT COMPLETES THIS SECTION Date: j ,, /
/ - (/
City, Town or Township !,; �.-4- /z,,, „ 0 r. s f County , s) u= i:".-17-"L.) State i
Location/Address ,,�y j/ 4/, //i,,7,�/- ; i�-f A ,f i U a l i /1 r'E-- /,
(If Located in Rural Area -Please Attach Directions) Pole # L"1, 1/v r
Owner,17 li 1 , 13,1 „,-, != i ri, ,•,. , i ,1‹:-:(_•- '/_- !f!, ir'/ S _Permit #
Occupied As _� S. j y A!- - r i- - Building: New Old I I
Occupant / f
Work Area in Building (Floor #,etc.):
App. for: Wiring❑ Service n or: ( r Gi?4 i•- /. 6, fi7 r-ir✓�. Ready for Inspection:
Fee Remitted- $ Cash I r Check n ry M.O. 1 1 Make Payable To: M.D.I.A.
500' 750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Number of Rough Wiring Outlets Elect. Heat
Switches
Lighting Amp. Service Surface Unit Dishwasher Range
Receptacles Water Heater Air Conditioner Dryer Pump -
Number of Fixtures Oven Garbage Disposal Wiring and Controls for "Burner
Amp. Receptacles Fractional H.P. Vent Fans
Other Equipment:
MOTORS H.P. 1/201/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1:l2 2 3 5 7:/2 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size
Applicant's / �,
Signature ,, f 1;���/ } j ''-`1.----- License # Permit #
T/A �l Utility:
Applicant's Address: � L, L (NAME) (OFFICE LOCATION)
/
(City) =,� ' ;,,, 0 . ��,/ (State) .� : -./ (Zip) / 2.- S'a Service Request #
-
Phone* d— / _ Electrician:
MDIA USE ONLY DATE RECEIVED: DATE INSPECTED:
Correct Location: Same as Above? or:
Red Notice Label I 1
Rough Wiring Outlets Surface Unit Oven
Switches Range Garbage Disposal
Receptacles Water Heater Dishwasher
Fixtures Air Conditioner Dryer
Amp. Service Equipment Burner, Wiring &Controls for Amp. Receptacle
Amp. Service Conductors Pump Vent Fans
MOTORS H.P. 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 P/2 2 3 5 7:/2 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size
500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Elect. Heat
CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECTFEE FEE PAID
RW Progress: Inc.1 I LKD❑ Contractor
❑ CFT Violation: Work Comp.n Inc. ❑
L/A Owner CASH n
n L/A Fee CHK #
Due MO #
IPA Municipal
INV #
•
Applicant
Date: Other Side n Utility
Owner
Cut in Card I 1 Temp # Date
•
Final # Date INSPECTORS SIGNATURE
APPLICATION FORM NO.250 EL 11/89
ELECTRICAL INSPECTIONS
DUPLICATE MUNICIPAL RECORD
Permit No.
qq A
Owner �rl ( /O _(yde-+-Q-J. . o/2.T. SE 21/7C C'
Occupant /'/ I , l�
Location I. 6 �� C /s4*'e ,5 -CAD A(I L�thT
No. Street
Town or City State
Installation as--itemized on reverse side has been visually inspected pursuant to applicable
codes. 7ACK / _
Installed by V AC^ (r � 21�15L q
C�/ fin. N ���,/l� 6
Date ` - 1! zykehi. _--.fir c�'4 nspector
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 - - `
/6 O AMP.SERVICE EQUIPMENT H.P.GARBAGE DISPOSAL UNIT
e a AMP.SERVICE CONDUCTORS 7K.W. DISHWASHER
r% K.W.SURFACE UNIT K.W. DRYER
K.W.RANGE AMP. RECEPTtCLE
K.W.WATER HEATER FRAC.H.P.VENT FANS
MOTORS H.P. 1/20 1/12 1/10 1/2 % ''/ 'h 'h ' 1 11/2 2 3 5 71/2 10 15 20 25 30 40 50 75 100
MARK NUMBER
OF EACH SIZE
APPARATUS -5674/1'GC Q 4JL y
•
TO MN OF QUEENSBURY
_/ n, 531 BAY ROAD
` ,fj.,', QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
....DUILtING INSPECTOR'S REPO 3T
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED
NAME tfrJ ftyf _Ao
LOCATION1
DATE //514/ • PERMIT# -0
TYPE OF STRUCTURE `71tak 4S.e r
-4 RECHECK p„ h i� d ant - ,
FIRE MARSHAL A�0 AL (COMME CIAL ST U TURE)
_FOOTING FOUNDATION BAC FILL FRAMING
ROUGH PLUMBING FINAL ELE TRICAL _SEPTIC
OO
INSULATION WDSTOVE/FI PLACE:
SITE PLAN/VARIANCE REQUIREME.TS YES NO
_—
REMARKS,., i,, :� E . ,• : , !
1 u i t
' N/A YES NO
CHIMNEY HEIGHT/LOCATION g
B VENT/LOCATION 9 ./
PLUMBING VENT
ROOFING tl'
SIDING DECK/PORCH/STEPS/RAILINGSA
RELIEF VALVES / :!
FURNACE/HOT WATER OPERATTIING
BASEMENT INSULATION/DU TWORK .
INTERIOR TRIM/PRIVACY OORg
FINISH FLOORS:
BATH/KITCHEN WATER. IGHT '1
OTHER FLOORS SWEEP BLE A
OTHER FLOORS CARP TED t,
STAIR CLEARANCE/RAILINGS
HANDICAPPED ACCESS A
SMOKE DETECTORS / 4
BATHROOM FANS/WHOLEHOUSE FANS
ALL PLUMBING .FIXTURES OPERA1ING
GARAGE FIRE PROOFING 1
DOOR CLOSERS f X
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS i
DUMPSTER ',/ j
FINAL ELECTRICAL ! I/ '
OK TO ISSUE C/O OR C/C
ZWENTs: /
�v/M/ 7/�S/gg'
Strain 4J/Li4G// Za?-Lc_
// 4`3 Zo .
t76citf r2aet y5'3'3o
.4 5 c.'113-07 - 9-- V - D 7
ARRIVE lam. 3 0
DEPART ,.5'0 -
L (' .
TOWN OF-QUEENSBURY
-DING AND CODES DEPARTMENT
531 BAY ROAD
IUEENSBURY, NEW YORK 12804
' TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
f FOR INSPECTION RECEIVED __5,� /G/
Y.)04 ha/A.iii-4,,./
,ATION X/ � 6!2 d A --
ATE V(5 % PERMIT
TYPE OF STRUCTURE /1406/4-149/14/-- ) (C'CO
RECHECK APPROVED
N/A YES NO
FOOTINGS(PIERS
MONOLITHIC POUR FORM
REINFORCEM T IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING,PROTECTION FROM
FREEZING FOR 4a HOURS FOLLOWING
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR TNJS PURPOSE ON S TE
FOUNDATION/WALLJafn"
_REINFJ'rs''"�
�J�1�j
�` , )° 'CE r
cG:)��l
v��� �
71
ç&rL- ,, )T \ ' '~,.'
H EE pot
INS
Fi ',
FC
FL R-
WA, R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
S C S /Z'iH2 Sao,2
ArIL6 0 j'i AI/)-L C,6P_T1Zi('4 L.
iV213 j ASiu� C)Af of r LOC(
BG�LT()
Cr-tom ,'-or i-( NA--L /DVS (4 't70)
ARRIVE ` r906
DEPART Q:3S-
INS CT
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12804-
TELEPHONE (518) 792-5832 •
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME //,4AJ[)L +/(p `/7 U i M
L_
LOCATION cr 6 `1,1Q,4i, 7Tm/l[j LL 467,
DATE 5/P,,e/9 f PERMIT # 9 f O
c APPROVED
1 Q 1ZTr A(o c�krum CMG S YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS \ % ' '
WALLS 7
CEILING \
FINAL INSPECTION: \
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STE S,
STAIRS-CLEARANCE & RAIIL'S
PLUMBING FIXTURES/RELLIEF\VALVE
INTERIOR TRIM/PRIVACY DOORS
FINISHED FLOORS I
GARAGE FIREPROOFING9 \ •
DOOR CLOSER(S)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTION . . ''
FINAL APPROVAL OF CONSTRUCTION ',"
OK TO ISSUE C/O OR .C/C
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS //40k /roo(a)t AAA- J !?-
(�1 L50,L/-c-ry v 'Iy =s/z op,/
ARRIVE 7)-L0
DEPART .5- �lCj
INSP CTOR
TOWN OF QUEENSBURY Papa
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED �p
NAME /14(1/Ycni_en L,glf,J /1 1(itizdo rl,C��/vycJ
LOCATION ' � r i6' P ; g 7)7m a Gd )/1e' -
DATE ,3/ /cj/ PERMIT # 9/- Gi:ad
TYPE OF STRUCTURE `g,(jque_ & `/gam--,C_e
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
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
PLUMBING VENT/VENTS IN PLACE •
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING ROUGH-IN
INSULATION: 1
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS 1 R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES °,
REMARKS: y
6 . it z QGCc'(-'4"/(v& C M&
) aa
ip ati P /K (r 0L )
(C�rYo,
ARRIVE 3-f 0
DEPART -9=3(� /%6
INS CT
elf TOWN UEEN B R OF Q S U Y
Bay at Haviland Road, Queensbury, NY 12804-9725-518-792-5832
Building & Codes Department
INSPECTOR'S REPORT
19
licy44.51-6 IV, Vt LC/t 6" • ;t f M t cr( ZZ
PROPERTY LOCATION
M ALOAL- LAU/e
OWNER OR TENANT
BUILDING SEWAGE SIGN OTHER
REMARKS: Iq (614&C24--0
:A% L-ct—
0556-5:9'‘-- )
PL rc4430,) LE)7
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I 1 01,(.5 L-D Cn 4-4_ I 7 ( Y "i ci iil/
A.4 IT— ° r c OCC c 1PA-AIC
CONTACT THIS OFFICE WITHIN •
INSPECTOR
"HOME OF NATURAL BEAUTY.. .A GOOD PLACE TO LIVE"
SETTLED 1763
" JAN 25 .rS1:T3 09-MORTGAGE SERVICES 802 555 5807 P.2/2 F
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