1991-221 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 117(i®� -3 19 qi
This is to certify that work requested to be done as shown by Permit No. q 1-221
has been completed.
This structure may be occupied as a simile family mobile home
Lot 48 Nomastead Vlg, Luzerne Rd
Location
Homestaed Village (Mendal/Lavin)
Owner
By Order Town Board
TOWN OF QUEENSBURY -
Director of Bldg. & Code Enforcement
•
BUILDING PERMIT -�
TOWN OF QUEENSBURY
No. 91-221 v
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to HOMESTEAD VILLAGE N
OWNER of property located at Lot 48 Luzerne Road Street, 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.
1. OWNER'S Address is
same
m
2. CONTRACTOR or BUILDER'S Name
Lamplighter Homes o
1-1
3. CONTRACTOR or BUILDER'S Address
RD#2 Saratoga Rd
Fort Edward NY 12828
4. ARCHITECT'S Name
5. ARCHITECT'S Address
r
6. TYPE of Construction—(Please indicate by X) 0
ei-
( )Wood Frame ( ) Masonry ( )Steel ( ) . Co
7. PLANS and Specifications
No. 14'00' 1988 Mobile home as per plot plan, specifications and
application.
8. Proposed Use
Single family mobile home
$ 35.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 23 92 19
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the N
town of Queensbury before the expiration date.)
O
Dated at the Town of Queensbury this 23rd Day of April 19 91
SIGNED BY for the Town of Queensbury
Building an ,Z rfir Spector
0101[01!
TO DE COMPLETED BY uric. DEPT. /' //,�/
_Juwn 01 QUeenJGurr Application No. , •
•
• BUILDING anu ZONING DEPARTMENT Permit Issued 19
Day ono Heviland Road, R.O. 1 Box 08 Permit •Expires 19 TQ. �' nr flt=54EWBURY
Zoning Designation
— ' '`
Ouuunsoury, Now York 12801
Variance No.,
Site Plan 'Review'No. •
•
APPLICATION FOR • Approved bye APR 19.i9'91
MOBILE HOME • • B IjG. & CODE DEPT.
PUILDING AND ZONING PERMIT ! �J5••• •
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
Le done in accordance with the description;_.plane:and specifications submitted, and •such- '
special conditions as may be indicated on the Permit.
rt;
•
1'he owner of this Rroperty is: C 9
P.O. Ad U r e u s 1� -1�1i�11_, Cell ��G�C
/ Tel
Property Location: "�"'
Street Number or building lot number /•U.6 ax Map No._1_f_
:;uLdlvision name (if applicable) •
diPIIE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS DUILDINC CODES IS:
711/ 1221,LYIU�e. Arf ianZ , tom' ed%ii-ita, y • . „
II ne - . .P.O. Address . - • Tel. No.
Ial1e of Installer �,t� p G t1q
i.,mc: ul plumber �I: cr ddrees,e� F—siT (�' C Tel. �l0 �//3`��3 ?��-
Addreuu a e, 6 Tel. re u o-
::,ua: of u►.iaon le' ce
Address it r. Tel. « - , (4 •.
tOD I LE HOME INFORMATION:
. • . ZONING INFORMATION: •
•
I e w Home Placement . . .. ' A N.M. PLAN MUST BE PREPARED. AND SUBMITTED, .
.eplacing existing Home. .-drawn reasonably to 'scald and'attached ,hereto, -.
• uhowing clearly and•distinctly all. .buildings, -
:ize of new Home
// ft X .7v ft . • whether existing or proposed and indicate all
:angle w` le �/ Double wide •.set-back dimensions from property lines. Give_.
• street and number or lot number and indicate .
io, of rooms (excluding baths) • whether interior or corner lot. Show location
1 ":,' •';of water supply and location and configuration
to. of 'bedrooms • , f septic disposal area.
•
Io, of bathrooms il •
COMPLETE INFORMATION REQUIRED BELOW.
•ireplace? — Wood stove? ' Size of
property 44 ft X . hto ft.
oundation style and size: • Existing buildings) Size ft X ft.
•ier.s- No.of Size- •• ft x ft. • Existing building(s) Use
•
•
Depth below grade ft.
OUNDATION •
_ Footing size " X �� Yropobed building, distance froul property line
gall material �f - . Front yard ft Rear yard ft
• Side yards tt and . ft
all thickness " Height ft. • If on corner, setback from side arrant tt •
•
otal depth below grade ft. OCCUPANCY 1NFORMATICN •
r
rade to Home floor level . ft. . PRIMARY DUILDINC -
, One family dwelling
Two family dwelling
roposed date of placement ? /�o/�•• _Multiple dwelling / Number of units
prox. Value. of Home S...M/ /94-6 • • . Perm anent occupancy
ater supply - Well Municipal • Transient occupancy
• —Dusiness
'.--4-2 --- . ' Industrial
optic Permit required? • OChur
• If addition, what will use be?
URTHER INFORMATION REQUESTED •
• ACCESSORY DUILDINC-
N THE REVERSE SIDE OF THIS SHEET.* Detached garage/one car/ two car/ . _car
' Attached garage/one car/ two car/T----1 car
• • Private storage building
•
• Other
• r
•
Form MII P 5/86 mcl-vl
APPLICATION FOR MOBILE HOME PERMIT, (CONTINUED)
State of New York Division of Housing and Community Renewal
INSIGNIA''' OF APN'KOVAL OF THE STATE . BUILDING CODE
. INSIGNIA SERIAL NUMBER
NAME OF MANUFACTURER -.1-)d f,�rdilL4
PLAN APPROVAL NUMBER •
•
. MODEL OR COMPONENT DESIGNATION -41 te,r,e-A-4-ir
•
•
MANUFACTURER'S SERIAL NUMBER 70/0 '_: •
DATE OF MANUFACTURE. , /9
•
All the above information is to be found on a plate or sticker which
:ou ld be affixed to the Mobile Home. Complete .above with that information.
4 e - # # 4 4 ♦ ' 4 # # # # .#, # #.: 4; 4 4 .•4. 4 '4 .. 4 4 # # # 4. 4 # # * 4' 4.4 .' 4 # '4
:own of Qucensbury:ounty 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.
n this application, together with the plans and specifications submitted, are a -true and
omplete statement of all proposed work to be done on the described premises and that all
,rovisions_ of the ::BUILDING CODE, THE ZONING ORDINANCE,-and--all other laws pertaining to
he proposed work shall be complied with, whether specified or not, and that such work is
uthorized by the owner.
•
Signature "11/41.4-1
Owner, o er'e gent rcnize ,contractor
•
• * • * • • * * •* a * a t * t t t • * • • * t • t t t * * t * * a .t t t * * * t t t t •t•
-
;PECIAL 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
TEMP.H DATE �.fl ^ /
CITY OR VILLAGE TOWNSHIP COUNTY
>( l,fj- 'L+_-4--^;-Lt.t1_ i;�)-;' ;:,.'." (.!. CL,l-/`-e-•-4_,)
STREET AND NO-OR ROAD _ A r% , ;J /' POLE NUMBER
✓ ,it _;/,� iii,?-)",l--!„!,C".=.,t- i'(v ,GYM .,Ti.,- E..L.,-: t %-s,.. ._.-_ / _•Pf_d.✓,
BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT
OCCUPANT'S NAME „_.; / ..')/ BUILDING OCCUPANCY
-OWNER'S NAME AND ADDRESS,, I) HOME,TELEPHONE N MBER 7r
CURRENT SUPPLIED BY ii j/ FnM THEIR .I OFFICE WORK TELEPHONE NUMBER
i 1)/i () l�,61..•ti,..-6 /f :. ,r.. �%
BUILDING IS
NEW❑ OLD❑ WORK IS NEW❑ ADDITIONAL❑ DEFECTS REMOVED❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS No.of Fixtures& MUIURS 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 ELECTRICA DEVICES OT SET FORTH ABOVE.
I �)_1! / )..-i 7'�1/`) (_lJ_ !Z i,--�/I *
/( -6 !-r: aA; +:..1
f,i%r%�;!/_/• tee+_'/41,4- �`," v,,L-f,,s ✓ ✓--,
• •._ _.-
1 HIS APPLICATIONAS INTENDED TO COVER T)4E ABOV lel/STED 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 OF WORK ❑ EXPOSED GAS TUBE SIGN/TRANSFORMERS OF VA
❑ CONCEALED
DATE WORK TO BE STARTED DATE COMPLETED SIZE OF SIGN(NUMBER) CAPACITY
SERVICE ENTERS BUILDING MANUFACTURER OF SIGN
❑ OVERHEAD ❑ UNDERGROUND
DATE INSPECTION REQUESTED ON(OR AS NEAR AS POSSIBLE) MUST ENTER APPLICANTS
IDENTIFICATION NUMBER
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; � e• / -- !DATE OF APPLICATION SIGNATURE,OF PPLIOANT
I ry a 7 / i 7�' ._ f 4,• '//i !I:
(%;;{ _�yf—�� l'•�r_)rt-rjj�l`l /.t�s li' .,._l` L. /off jT.-� ! �f X r,r•�zA;a.. -,�'� �Y:�J:,�.f
STREET ADDF}ESS ( /- r; T�PHO ENO.
�CITY`OR POST QFFICE' , ! ZIP CODE LICENSE NO.WHEN APPLICABLE
�t 1! 1 .i2U/ /' , //7 /2-`</i '.
❑ 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
(212)227-3700 (518)463-2122 (716)884-1155 (716)254-0141 (315)463-8552
TI-IP NPW VnRK R()ARf f F FIRE '.INDERWRITERS
si."..\n"..,..!."""..1,!.-1 ,,,.J.ti"e�..�t"..1,!Ca,,.I ".In.1,�(,a,t"".?•!_epy,„""..1,)„":".1,1").,..4?..,".1 Av.i.""""„ .•,,!,,,.),i.1,,:".an""" Ui,".1 !..),,
THE NEW YORK BOARD. OF FIRE UNDERWRITERS
PAGE 1NI
c3178G„1 BUREAU OF ELECTRICITY
, I" 41 STATE STREET.ALBANY,NEW YORK 12207
,, •
®.
.. Applica • : o.on file
�; Date MAY 13,1991 • 0682O891/91 II 411322
THIS CERTIFIES THAT n, T T �} �'•�
�, PP_ :I1T A0. 17221 ®.-
'c' only the electrical equipment as described below and in aced by cant named on the above application number in the premises of
Vic' • • ;:
1: D.AVID & JITDV RPODES NORTHI.`I+i S NOBIIE1 f1OHE PARK, OUEENSBURV, N.l'. ..
- ,i' in the following location; ❑ Basement ❑ 1st Fl. 2nd Fl. OUT Section Block Lot .rs ; ='
j; was examined on and found to be in compliance with the requirements of this Board. '•
•IiA1 01,1. 91
% FIXTURE �� FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS ".
i:: OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. ':�
t' DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gEU UNIT HEATERS MULTI-OUTLET DIMMERS
,1r
•
' AMT. K.W. OIL H.P. GAS H.P. AMT. - NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS.® H.P. NO.OF FEET AMT. WATTS ';
i; SERVICE DISCONNECT NO. S E R V I C E �
�: AMP. TYPE METER 1,B'2W 1 A 3W 3$'3W 3,B'IW NO.OF C$COND. OF CC.CON'D. NO.OF HI-LEG OF.HI LEG NO.OF NEUTRALS OF N UTRAL ';:i
,ir,6 OTHER APPARATUS: •
;is
o
_ gi: PACII LBOARDS:1-2 C:CR. 100 0V:
- 1.
-i• 9 1T
j: : L
i
e.: • i 4
1 •
-p t 4� r.
/
DOROTHI s MURRAY c.rul-e: .
i; LAMPLIGHTER HOMES BRANCH MANAGER
RT. 9 R.D2
FORT EDEARD, NY, 12828 239
Per
I; 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. :9:
�y;';.i;. ',• 5o ® oeo ® oe ® ® oaaoo ® o ® ear ® ® flifilliftilnifilEMESIESIE o ® o ® o ® '
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
TOM OF QUEEr SDURY /372)
{) 531 BAY ROAD
71 QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
DUILDIN , INSPECTOR'S REST
FINAL INSPECTIG 1
REQUEST FOR INSPECTION RECEIVED
LOCATION OL if 1
DATE L-1'/ %/ PERF1IT# 9/-z.2il
TYPE OF STRUCTURE
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFfLL FRAMING
ROUGH PLUMBING ANAL ELECTRICAL SEP..TIC
INSULATION WOODSTOVE/FIREPLACE
SITE PLAN/VARIANCE REQUIREMENTS YES NO
REMARKS
( I
APPROVAL
N/A YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION
PLUMBING VENT LI
ROOFING h i
- ---SIDING -" _ - '
DECK/PORCH/STEPS/RAILINGS f
RELIEF VALVES
FURNACE/HOT WATER OPERATING
BASEMENT INSULATION/DUCTWORK
INTERIOR TRIM/PRIVACY DOORS ?,
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
HANDICAPPED ACCESS
SMOKE DETECTORS ,/
BATHROOM FANS/WHOLEHOUSE FANSV
ALL PLUMBING FIXTURES OPERATING X
GARAGE FIRE PROOF,ING
DOOR CLOSERS f'
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS - -
DUMPSTER
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C
COMMENTS:
Ou&)I(1 LUtu- Ji s 'LI f2 o/J. .
ARRIVE .-26-
DEPART Z: �
/
TOW ' `f."E QUE.ENSBUR`t
APR 19 1991
BLDG. /It CODE DEPT.
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APR 197991
DLDG, CODE DEpT.
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