1991-209 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date n4,171it&L/ .22 19 9/
This is to certify that work requested to be done as shown by Permit No. 91-209
has been completed.
This structure may be occupied as a Mobile Hie
Location Lot #10 Homestead Village
Owner Homestead Village
By Order Town Board
TOWN OF QUEENSBURY
V
Director of Bldg. & Code Enforcement
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s _ 3
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-209 zo
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Homestead Village Ij
OWNER of property located at Lot 010 Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Mobile Home vOi
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. p,
1. OWNER'S Address is
Cu
ca
rD
r
2. CONTRACTOR or BUILDER'S Name O
Installer — Hubinsky's ttti
3. CONTRACTOR or BUILDER'S Address
O
Rt 9 Wilton
4. ARCHITECT'S Name o
tD
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel (
7. PLANS and Specifications
No 14'x 52' Mobile HOme as per plot plan specifications and
application
8. Proposed Use
Mobile Home
$ 17.00 PERMIT FEE PAID —THIS PERMIT EXPIRES September 19, 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 19th, Day Se tember 19 91
SIGNED BY C CGS' r/ for the Town of Queensbury
Building and Zoning I ctor
TO DE COMPLETED BY IILDG. DEPT. War
-awn 0/ Quee,.i1ur, Application No.
Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 TOWN OF QUEENSB f
Bay and Haviland Road, R.D. 1 Box.96 Zoning Designation RFr EFVFn
Queensbury, New York 12801 Variance No.
Site Plan •' ie No. AIR I 7 1991
APPLICATION FOR Approv -d .
,,,f// ' . •
• MOBILE HOME , �� A BLDG. G �vum L�
-
HIDING AND ZONING PERMIT ://7 ,. 9/-2 9 _ -
# iF iF iF it it i1 e e iF e • e • i %1F i 1F ♦ it * * �F �F �I it 11 1� �F ir, �► M rF *::e
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: 7 ,/-7 -S 'TEilL7 4 ' 6 -
P.O. Address 7 U Z„ G• (a . 06 9i Tel. 790R -r)you
Property Location: eLo -7 =,�-- /0 - • Tax Map No. l /
Street i;umber or, building lot number
Subdivision name (if applicable)
TILE PERSON RESPONSIBLE FOR SUPERVISION OF'WORK AS. REGARDS BUILDING CODES IS:
COG 1 E 6„i C@ /S 7 M.e2-n d o e_o."eti 14 dc f in y PO d dx /3s9 9 1/6em_y,/,22 17 _:-
Name P.O. Address Tel. no. goe--�33 _651,a
Name of Installer ()e/r.Ltyrs Address 9 . 6/0/y,V Tel.
Name of plumber Address Tel.
Name of mason Address Tel.
MOBILE HOME INFORMATION: * . ZONING INFORMATION:
New Home Placement .. * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
-* drawn reasonably to scale and attached hereto, -
Replacing existing Home y ,� * showing clearly and distinctly all buildings,
Size of new Home P7 ft X..j ft . � * whether existing or proposed and indicate all
•y * set-back dimensions from property lines. Give
Single wile /l Double wide * street and number or lot number and indicate
No. of rooms (excluding baths) 9/ *. whether interior or corner lot. Show location
* of water supply and location and configuration
No. of bedrooms * of septic disposal area.
*
No. of bathrooms 1 * COMPLETE INFORMATION REQUIRED BELOW.
Fireplace? Wood stove? * Size of property (' O✓ ft X `/0 ' ft.
Foundation style and- size: ; Existing building(s) Size ft X ft.
Piers- No.of Size- ft x ft. * Existing building(s) Use
• *
Depth below grade ft. . ,
* Proposed building, distance from property line •
FOUNDATION - Footing size. " X so
* Front yard Oa ft Rear yard .�6 'ft
Wall material * Side yards 518' ft and 6 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 3 0"ft. * PRIMARY BUILDING -
. . * * * * * * * * * * * * * * * * * * * _120One family dwelling
/n/ * Two family dwelling
Proposed date of placement y / 2Y/ %/ * Multiple dwelling / Number of units
Aprox. Value. of Home $ `aip0® * Permanent occupancy
* Transient occupancy
Water supply - Well Municipal * Business
/® * Industrial
Septic Permit required? /(J * 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/-T 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 APPROVAL OF THE STATE ' BUILDING CODE
1 . INSIGNIA SERIAL NUMBER —' U
2 . NAME OF MANUFACTURER
3 . PLAN APPROVAL NUMBER /6
4 . MODEL OR COMPONENT DESIGNATION
•
5 . MANUFACTURER 'S SERIAL NUMBER •
6. DATE OF MANUFACTURE •
/Zie9M6
GO/ • 1/971% -/1/ hJ/': ' / ` 71. /t7'S o •
•
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.
* * * * h # * 4 * * 4 h 4 * * .* # +F +F * +F * A 4 4 * * * 4 4 4 * h *4 * * 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 specified or not, and that such work is
authorized by the owner. .
Signature ____ __ _ __ ______ ___
Own,6 , 'own/r's gent rcnitec ,contractor
7QB-- 603 Z
•
* * * * * * * * a a * * * * * a * * * * * * * * * * * * * * * * * * * * a * a * * * * * •*
SPECIAL CONDITIONS OF THE PERMIT:
•
•
•
•
•
•
• By
•
YOU ARE HEREBY REQUESTED TO
INSPECT AND ISSUE CERTIFICATES .
' FOR THE FOLLOWING ELECTRICAL
•
EQUIPMENT-TO BE INSTALLED BY
THE UNDERSIGNED• .r
1 '
TEMP.!i � DATE L�'1 J - tj�� r f.•f
CRY OR VILLAGE TOWNSHIP COUNTY
( tJ E Enaa 6 ire /.v rare/0(•T�
STREET AND NO.OR ROAD POLE NUMBER
o Sr '?9 14e-C. /766 C . -/0 - •
BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? /'�^''/) / SECTION BLOCK LOT
SS
OCCUPANTS NAME BUILDING OCCUPANCY
OWNER'S NAME AND ADDRESS ,� HOME TELEPHONE NUMBER
{�eDr.r .S7f/lJ f/ c4e.r7G /v�rT�e �-- =r 799„?-- `f00
CURRENT SUPPLI Y FROM THEIR OFFIC WORK TELEPHONE NUMBER
Ate; 'Z o cc;�V 7-2e c S
BUILDING IS
A`• NEW t OLD
WORK IS NEW❑ ADDITIONAL❑ • DEFECTS REMOVED❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS No.of Fixtures& MOTORS HEATERS BRANCH OFFICE USE
Loca- Lamp Receptacles ' CIRCUITS ONLY
tion Side Attach't • H.P. ' Watts A.W.G.
Ceiling Wall Recep'Is Switch Pendant Bracket No. Type Each No. Each No, Gauge INSPECTION
OUT-
SIDE _
SUB-
BASE•
BASE-
MENT_.
1st
FL.
2nd
FL.
3rd
FL
REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE-
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.
SIZE OF MAINS FEEDERS ELECTRIC SIGNS/LAMPS TOTAL WATTS
CHARACTER OFF WORK ,A' El EXPOSED GAS TUBE SIGN/TRANSFORMERS OF VA
V''?1?/(�e 7 r/✓:4)./7i` ,z / )i7? ❑ CONCEALED
DATE WORK BE START D DATE COMPLETED SIZE OF SIGN(NUMBER) CAPACITY
?S >��/
SERVIC NTERS BUILDING MANUFACTURER OF SIGN
❑ OVERHEAD E UNDERGROUND
DATE INSPECTION REQUESTED ON(OR AS NEAR AS POSSIBLE) MUST ENTER IDENTIFICATION NUMBER
I/CC- �. _9/ (
AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
PRINT NAME AND ADDRESS
NAME OF APPLICANT DATE OF APPLICATION SIGNATURE OF APPLICANT
X
STREET ADDRESS . TELEPHONE NO.
CITY OR POST OFFICE - ZIP CODE LICENSE NO.WHEN APPLICABLE
❑ 85 John Street ❑ 41 State Street ❑ 570 Delaware Avenue ❑ 217 Lake Avenue/ ❑ 202 Arterial Road -
NEW YORK,NY 10038 ALBANY,NY 12207 BUFFALO,NY 14202 ROCHESTER,NY 14608 SYRACUSE,NY 13206
THE NEW YORK BOARD.OF FIRE UNDERWRITERS
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THE NEW YORK BOARD. OF FIRE UNDERWRITERS PAGE
42.0670•1 BUREAU OF ELECTRICITY
41 STATE STREET.ALBA -NEW—YORK 12207
Date OCTOBER 30,1.991 Applicatio i o.on fil -179 9491/91 A 06060-I
THIS CERTIFIES THAT PERMIT NC,. 91-209
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
HOMESTEAD VILLAGE, ILOMESTEAD VILLAGE, OUE.ENSBURY, _N.Y.
in the following location; ElBasement ❑ 1st Fl. ❑ 2nd Fl. OUT Section Block Lot la
!
was examined on OCTOBER 2 4,19 91 and found to be in compliance with the requirements of this Board. ®1
FIXTURE I FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
=
OUTLETS ECEPTACLES SWITCHES INCANDESCENT.FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
1. I.,
:Y
DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
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 SYSTEMS AMT. WATTS
SERVICE DISCONNECT NO.OFI.
S E R V I C E
AMT. AMP. TYPE METER �,2W 1 3W 3�'3W 3 SW NO.OF CC.COND. A.W.G. NO.OF HI-LEG A.W G. NO.OF NEUTRALS A.W.G.
EQUIP. PER B OF CC.COND. OF HI-LEG OF NEUTRAL
OTHER APPARATUS:
= PANELBOARDS:1-2 C;I R. 100
II
TODAYS MODERN HOMES
54 ROUTE 9
24.71:7.
E.
_ �i G�NSE�OORT; N , 1^�t31 BRANCH MANAGER
239
Per
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. i~
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COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. L
TOWN OF QUEENSBURY M
M 531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED
MAME /9 / 7P'rl-49//v e4 747
LOCATION X f /O /c-77(a4/ z/ y,eq.
DATE fOki/ PERMITS 91,fe
TYPE OF STRUCTURE 322,(Agiei' /JAY t
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING FINAL ELECTRICAL _SEPTIC •
INSULATION WOODSTOVE/FIREPLACE
REMARKS
APPROVAL
d�N/A YES NO
CHIMNEY HEIGHT/LOCATION /{
B VENT/LOCATION i {'
PLUMBING VENT \ /
ROOFING
SIDING
DECK/PORCH/STEPS/RAILINGS /'
RELIEF VALVES •'z I
FURNACE/HOT WATER OPERATING
BASEMENT INSULATION/DUC:TWORK
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS:
BATH/KITCHEN WATERTb. HT,
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED
TQIR CLEARANCE/RAILINGS
HANDICAPPED ACCESS ,'
SMOKE DETECTOR_____ ,
BATHROOM FANS/WHOLEHOUSE FANS
ALL PLUMBING FIXTURES OPERATING
GARAGE FIRE PROOFING
DOOR CLOSERS
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS,
.DUMPSTER A
SITE PLAN/VARIANCE REQUIREMENTS. \ f
FINAL ELECTRICAL +/
OK TO ISSUE C/O OR C/C c/
COMMENTS:
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5 M/4e; a4",. Ae-z4 e6/
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ARRIVE f
DEPART �J-
INSPECT R
A'S �eA TOWN OF QUEENSBURY 7 O
BUILDING AND CODES DEPARTMENT (8
��� 531 BAY ROAD �(��
Q' UEENSBURY, NEW YORK 12804
,r��( TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED ?1/(�,/%/
NAME \C YJ1 I a. f-�rYYLp JJ !!
LOCATION kioYYI eS _,Q )I PC(
DATE 7/7/6II PERMIT I
TYPE OF STRUCTURE 4 ) J CX(�
6JG' �vt,�
RECHECK ��N APPROVE
L
IN/A YES NO
FOOTINGS/PIERS 1
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM l`
FREEZING .FOR 48 HOURS FOLLOWING
THE PLACEMENT OF THE CONCRETE. 1
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR I/ /
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING i A`
PLUMBING VENT/VENTS IN PLACE /
PLUMBING UNDER SLAB ,t
FRAMING:
JACK STUDS/HEADERS ;�
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
FIRESTOPPING '
WALLS f/
CEILING / 'J
FIREWALLS �" I
HEATING ROUGH-IN g i
INSULATION: / 1
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXT RIOR R- 1
FLOORS R-
WALLS R-
CEILING A R- 'I
DUCT WORK OR PIPING IN UNHEATED
SPACES i
REMARKS: / /
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