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1991-171 • MI!Jn(E T y f,0 CERTIFICATE OF. OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date 1110/; ff 19 This is to certify that work requested to be done as shown by Permit No. 9]L 171 has been completed. This structure may be,occupied as a Mobile Home Location 16 Minnesota Avenue Owner Raymond Adams By Order Town Board TOWN OF QUEENSBURY �-o-�- , Director of Bldg. & Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY No. 91-171 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Raymond Adams V Avenue OWNER of property located at 16 MinnesotaStreet, Road or Ave. ~'' 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. 0 1. OWNER'S Address is PO Box 179 a Fort Ann, flY 12827 2. CONTRACTOR or BUILDER'S Name Wilber Williams `tl 3. CONTRACTOR or BUILDER'S Address a fD rD fD 4. ARCHITECT'S Name fD 5. ARCHITECT'S Address 3 CD 6. TYPE of Construction—(Please indicate by X) ( )Wood Frame ( ) Masonry ( )Steel ( ) 7. PLANS and Specifications No. 14' x 70' Single wide mobile home as perplot plan specifications and application 8. Proposed Use Mobile Home $ 35.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 10, 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 t D y of April 19 91 SIGNED BY —i</ for the Town of Queensbury wilding and Zoning Inspector e * n TO DE COMPLETED BY BLDG. DEPT. /awn o� Qu4'e,ii1u,, Application No. Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit •Expires 19 Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation I OWI OF QUEEN URY Queensbury, New York 12801 Variance No., RECEIVED Site Plan Review No. • APPLICATION FOR - - •ro ed by, . . • PR 91991 MOBILE HOME /t ?e4 i : D . & CODE DEFT. PUILDING AND ZONING PERMIT 's5 .) . * * w * .• * * it * * * * . * * 4 * * ` * * 4 * * * * a * * * a * a * * * . ::* 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. The owner of this property is: f. ra�.yrno,�Jw C. Acgrns. P.O. Address 'P• p. u{�X 179 l .,RA- AVN "J•1 /a0O e27 Tel. 7.7 3'S8/c2 Property Location: A-6:f i?,JN€5of0. kue Tax Map No. 0 7/ ` / n Street i:umber or building lot number Subdivision name (if applicable) /� THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK]AS REGARDS BUILDING CODES IS: Ray,>10 e•Acie S Pc). 6o< 179 FR+AN� /U•y. i .27 79.E-S-8/a Name P.O. Address Tel. No. Name of Installer U), I �e2 1.Jnc'"5Address Tel. 'VI 3 - r713q Name of plumber ko i laND Ca2a u•es Address Narfco szD Tel. (o 3 3 - 5 3 Name of mason c243I IczD r 24ues Address bio2+f6R D Tel. (P 3 a -5-6,,, 2 o 63 9 _ Lig . MOBILE .HOME INFORMATION: T * . ZONING INFORMATION: 3- New Home Placement i ) - ET * A PLOT PLAN MUST BE PREPARED AND SUBMITTED, 7 drawn reasonably to scale and attached hereto, Replacing existing Home * showing clearly and distinctly all buildings, Size of new Home 4ft X 76) ft • • * whether existing or proposed and indicate all •\/ * set-back dimensions from property lines. Give Single wile • !' Double wide * street and number or lot number and indicate * whether interior or corner lot. Show location No. of rooms (excluding baths) L' * of water supply and location and configuration No. of bedrooms * of septic disposal area. * No. of bathrooms * COMPLETE INFORMATION REQUIRED BELOW. Fireplace? $JCO Wood stove? WO * Size of property 90 ft X . /DO ft. • Foundation style and size: Existing building(s) Size — ft X — ft. Piers- No.of Size- ft x ft. * Existing building(s) Use N /A * / Depth below grade ft. . • FOUNDATION - Footing size S X �(o.�� is. Proposed building, distance from property line material ac O J 51 . r6Ncre 6* Sidetyards 10 yard 30 ft Rear yard (9 (o ft Wa3 s�f� Side ft and /0 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. ▪ PRIMARY BUILDING - * * * * * * * * * * * * * * * * * * * * * LOne family dwelling * Two family dwelling Proposed date of placement (o / / / CJf * Multiple dwelling / Number of units Aprox. Value. of Home $ jg 000. * Permanent occupancy ' • Transient occupancy Water supply - Well Municipal ' * Business * Industrial Septic Permit required? / 4 * 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 • 1 APPLICATION FOR MOBILE HOME PERMIT, (CONTINUED) State of New York Division of Housing and Community Renewal • INSIGNIA ::.OF' APPROVAL OF THE STATE BUILDING CODE 1 . INSIGNIA SERIAL NUMBER 5 -" 2 . NAME OF MANUFACTURER S K't/ f!N'e C6 P rout u fru, • 3 . PLAN APPROVAL NUMBER 4 . MODEL OR COMPONENT DESIGNATION 0 f 4 ` - '7 3 -I 7 Z • • 5 . MANUFACTURER ' S SERIAL NUMBER I g I(e — Oa 7s Z 6 . DATE OF MANUFACTURE g- as- 8 q 1-� u o # u T 3 / 9 7 • • • • 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 a * * * 4 ; +t :* .* * 4 • 4 * 4 * * 4 4 * * 4 4 44 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 __ __ ___ Owner, wner's agent,arcnitect,contractor • * * * * * * * * * * * * * * * * * * * • • * * * * * * * * * * * * * * •* * * * * * * * * * 'a SPECIAL CONDITIONS OF THE PERMIT: • • • • , By • �° MIDDLE,DEPARTMENT INSPECTION AGENCY, INC. ,-. National Headquarters 1337 West Chester Pike,West Chester, PA 19380 APPLICANT COMPLETES THIS SECTION Date: 4 _cJ_cl/A City, own r Township ( _{ uJ t \;t.:Z V County 1_0c, ;) A(7A) State AI .y Location Address /(,. (r)(.'.4 Al.'c o-i. A,'E. (If Located in Rural Area - Please Attach Directions) Pole # Owner 17,-.. mrk,J::, r . A r. s-. - Permit # `r/-- i'i',/ Occupied As . . • . r Building: Newn7! OldJ Occupant Work Area in Building (Floor #,etc.): • App. for: Wiring❑ Service or: . Ready for Inspection: Fee Remitted -$ Cash n Check Ti M.O. n 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 v 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 P/2 2 3 5 7'/2 10 15 20 25 30 40 50 75 100 Mark Number ' of Each Size Applicant's ' Signature (2—1_ "'" j' .7' License # Permit # T/A / Utility: • Applicant's Address: (NAME) (OFFICE.LOCATION) (City) • (State) (Zip) Service Request # Phone # Electrician: MDIA USE ONLY • DATE RECEIVED: DATE INSPECTED: V Correct Location: Same as Above I or: - Red Notice Label 1 Rough Wiring Outlets Surface Unit Oven Switches Range - Garbage Disposal Eeceptacles 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 1V2 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.❑ LKD-❑ Contractor ❑ CFT Violation: Work Comp.❑ Inc. ❑ - L/A Owner CASH El 1-7 L/A Fee CH K # Due MO # IPA Municipal . INV # • Applicant .❑ Date: • Other Side❑ Utility El Cut in Card f Temp # Date n Final # Date INSPECTORS SIGNATURE APPLICATION FORM NO.250 EL 11/89 - :: ..%„‘",.%f.A.OA,1/.AP01Pi.a•1,Act,11.1.Al.i.A M,._kW_A.It_McAN,OA..M."„,..�),AL.)."1 11.0.",.0Pt 1.1.1.s1. 1�a111.a i..M 111.,112.O.a t,",AI.�0,i.191,.1.1.Oi."M...M.�./.:1,,.�..",.k./".M." 1:,,91 .-,*'..0 K •.. THE NEW YORK BOARD. OF FIRE UNDERWRITERS i. PAGE r .1797: BUREAU OF ELECTRICITY 41 STATE STREET,ALBANY,NEW YORK 12207 Application No.on file \ .; Date MAY 15,1991 I� 0686749:l.!_31 H 411365 ')+ • t THIS CERTIFIES THAT nl/. ' - only the electrical equipment as described below and introduced lb the applicant named on the above application number in the premises of t. GARY & PAL.LETTE HAY', HINNEcCTA AVEr, TRAILER, OUEENSBURY, N.Y. ,' in the following location; 0 Basement C 1st Fl. 2nd Fl. OUT Section Block Lot ' !�. was examined on MAY 10,1991 .and found to be in compliance with the requirements of this Board. ;:• FIXTURE I FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS : 1 ECEPTACLES SWITCHES - � OUTLETS INCANDESCENT FLUORESCENT OTHER '"AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. .4 i �: �' DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI—OUTLET DIMMERS •` e. SYSTEMS c AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. _ AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS IP 4. .'� 3_. SERVICE DISCONNECT NO.OF _S : -""E • R V I ' C E ':L �• . AMT. AMP. TYPE EQU�F 1,e'2W 1,e'3W 3 II 3W 3,e 4W NO.OFER gCOND OF CC.COND.. NO.OF HI-LEG OF.HI-LEG NO.OF NEUTRALS OF NEUTRAL Ffe 1 Ft �. OTHER APPARATUS: i PANELB0ARDS:1-. CIF:. 100 .- j• i T 1 GARY & PAULETTE HAYES 1 (...._ ' RD 4, BOX 107 BRANCH MANAGER `: MINNESOTA AVE. ,. .. 1::,<(,: OUEENSBURV, NY, 12804 • 239 . -' Per -c • ; This certificate must not be altered in any manner;return to the office of the Board if incorrect. Inspectors may be identified by their,credentials. it-41--i. nnamincsonnsinsinanesmittraonsormilsonrimannesrso ® MEMO aaEVaa ® a MEW oo ;-r . COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. �s• TOW OF QUEENSBURY /q/2/1 531 BAY ROAD J „,5f QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 792-5832 BUILDING IfNSPECTOR'S REPORT FINAL INSPECTION REQUEST FOR INSPECTION RECEIVED MAINE 601/111-ina (fib LOCATION I tp `-(.),?! 4 a,t4 ct J) 1 DATE 4 8' /4 / PERMIT# q/-/i7 / TYPE OF STRUCTURE RECHECK FIRE MARSHAL_APPROVAL (COMMERCIAL STRUCTURE) FOOTING (-FDUNDATION BACKFILL FRAMING ROUGH PLUMBING FINAL ELECTRICAL SEPTIC INSULATION WOODSTOVE/FIREPLACE SITE PLAN/VARIANCE REQUIREMENTS 1 YES _ NO REMARKS !, v 1 APPROVAL �.k,. S' CHIMNEY HEIGHT/LOCATION N/A YE. NO B VENT/LOCATION p! r PLUMBING VENT F , ROOFING SIDING ,4 DECK/PORCH/STEPS/RAILINGS", ,° RELIEF VALVES FURNACE/HOT WATER OPERATING BASEMENT INSULATION/DUCTWORK ,/j INTERIOR TRIM/PRIVACY DOO S ,/ FINISH FLOORS: BATH/KITCHEN WATERTIGHT OTHER FLOORS SWEEPABLE OTHER FLOORS CARPETED STAIR CLEARANCE/RAILINGS " HANDICAPPED ACCESS `¢ SMOKE DETECTORS BATHROOM FANS/WHOLEHOUSE FANS e!/ ALL PLUMBING .FIXTURE$ OPERATINGpi GARAGE FIRE PROOFING/ I DOOR CLOSERS OTHER FIRE SEPARATI N FIRE/DEMISE WALLS DUMPSTER FINAL ELECTRICAL c✓'1 OK TO ISSUE C/O OR C/C COMMENTS: S 4ed t t L /3/ )75 er9 eA-f-WP?)Y12' 1Ge ARRIVE /D "'-- DEPART 1 d 15' a IN r , - TOWN OF QIIEENSBURY • 531 `;� j • QUEENSBURY,BAY NEWRYAD YORK 12804 • TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT FINAL INSPECTION` REQUEST FOR ;INS?ECTION RECEIVED ":00,4V NAf7E rW,OL did 49 J LOCATION PERMITS DATE / / 0///%7/ TYPE OF STRUCTURE ��, �� � RECHECK FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE) --ROUGH BACKFILL /FRAMING ROUGH PLUMBING FINAL ELECTRICAL -_SEPTIC • INSULATION WOODSTOVE/FIREPLACE SITE PLAN/VARIANCE REQUIREMENTS YES NO REMARK 6. i%. / APPROVAL N/A YES NO CHIMNEY HEIGHT/LOCATION t/ B VENT/LOCATION ' PLUMBING VENT iS ROOFING SIDING / 1 DECK/PORCH/STEPS/RAILINGS' ! I. RELIEF VALVES FURNACE/HOT WATER OPERATING BASEMENT INSULATION/DUCTWOR INTERIOR TRIM/PRIVACY DOORS t FINISH FLOORS: BATH/KITCHEN WATERTIGHT OTHER FLOORS SWEEP4BLE OTHER FLOORS CARPETED STAIR CLEARANCE/RAIUINGS HANDICAPPED ACCESS / SMOKE DETECTORS BATHROOM FANS/WHOLEHOUSE FANS ALL PLUMBING .FIXTURES OPERATINGt GARAGE FIRE PROOFING DOOR CLOSERS OTHER FIRE S P N • FIRE/DEMISE WALLS _ DUMPSTER FINAL ELECTRICAL OK TO ISSUE C/O OR C/C COMMENTS: ARRIVE • / ; (,' DEPART ,r /� /,,-r INS PE�'OR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 792-5832 BUILDING INSPECTOR°S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION / ` �%(ter4/ DATE q//,i �/�,/ PERMIT f 9�l7/ TYPE OF STRUCTURE RECHECK APPROVED N/A YES N 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. y7 MATERIALS FOR THIS PURPOSEON SITE `a FOUNDATION/WALL POUR REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFING BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/VENTS IN PLACE PLUMBING UNDER SLAB FRAMING: JACK STUDS/HEADERS ? a' BRACING/BRIDGING JOIST HANGERS JACK POSTS/MAIN BEAM f•. I4 FIRESTOPPING • WALLS CEILING FIREWALLS s� HEATING ROUGH—IN ,2 INSULATION: FOUNDATION WALLS I,NTEROR R— FOUNDATION WALLS ;EXTER R— FLOORS :f �'' R— WALLS f R— CEILING F^, R— DUCT WORK OR PIPING IN!,UNHEATED SPACES REMARKS: • to ARRIVE U19 DEPART 0 5 I NS PE TOR 1.1 pm„, Ne. sota - _ _ _ ... A v c — — — - -- — _ — — — — :1a1` -IQ -- T ►a?- 1-11 .. Ey;S+1N1. / 1a7-/-73-a rnNN;.le..1 ® wAki (3o Po w. Lo,k1DS 0kAlN4 ;,i '� �: KeN N et1�1 + Pa} °q v 1 c i r �2NDe < y z z ski . < •l, " Ntos ' 1 F g Pi,/• ell )• 3 6 U T ; / 1/1�b Z IDg a v 4 � ►a -Ey �..-Na — ? pj TOM OF QU SibUf.:: Ni...;la w - . � co /� v-� ,I, 1-we�1 C z . 6 i i IV ^� U Date —/-7.-S — I Feet n.. n..( t1 Pe4_S. 9 i 14' , 1� G u M.01461Avt 0,,.. Plot PIc 4 TOr2 W -I �p Kay man> C, AA,*r�S a _ O 1' � f1 C ®� i.. KC b 11O14�1a esoio, Apt. =� m© 1-ro0 (2okS aS ?£ roD 14 Iroofov s West Clelos Falls /''Y• . c� — ,,.� mm ( 000 P+\sc skkb (4'� t-hi'( 1) v rn m v) CoNcre}e = 3ccc . 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