1991-298 Iy•.r
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CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date May 20 19 91
This is to certify that work requested to be done as shown by Permit No. 91-29R
has been completed.
This structure may be occupied as a single family mobile home
Lot 55 Homestead Village
Location
Stacey M. Dixon- and Matthew S. Baker
Owner
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
.
BUILDING PERMIT
TOWN OF QUEENSBURY No 91-298
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to STACEY M. DIXON AND MATTHEW S. BAKER
co
OWNER of property located at Lot 55 Homestead Village 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
Mendal/Lavin
Homstead Village r_(
2. CONTRACTOR or BUILDER'S Name C4
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Lamplighter Homes
3. CONTRACTOR or BUILDER'S Address c-t-
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RD#2 Saratoga Rd 2
Ft Edward NY 12828
4. ARCHITECT'S Name
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Ca
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CD
5. ARCHITECT'S Address
Cl.
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6. TYPE of Construction—(Please indicate by X)
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( 1 Wood Frame ( 1 Masonry ( )Steel ( )
7. PLANS and Specifications r
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No. 14')(70' Mobile home as per plot plan, specifications and application. crl
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8. Proposed Use a
Single family mobile home
$ 35.00 92 cn
PERMIT FEE PAID —THIS PERMIT EXPIRES May 15 19
(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.)
O
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Dated at the Town of Queensbury asp 15th Day 19 91 of May
SIGNED BY I . _/�1� for the Town of Queensbury rD
Buildingand'Z ningInspector a
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ff TO BE COMPLETED DY fLDG. DEFT. .
c7�7
Uwn di QI urn Application No.
9 /' BUILDING anti ZONING DEPARTMENT Permit issued • )9 �-
Pesrmit , piree 19 �fJ U;,y un0 Huvil:end Road, R.O. 1 Box 08 Zoning Oea1g. .n `
Ouuun�Cury, Nuw York 12801 TO OF OLIEE) L)RY
. V•
arian a No , •R1=CE1V `)
Site Pi an - - .
APPLICATION FOR Appr I- •. IMY141991 -
MOBILE HOME I _ _�
f U I LD I N�- AND ZONING PERMIT , 1 ') A CODE DEPT
• • • •. •- * a * • • a e -• * a .•. a • t • *
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. ANSWER ALL OF. THE FOLLOWING.
The underuignud .hereby applies for a Building Permit to do the following work which will '
Le dune in accordance with th,e` deseription, plane-'and .specificationu uubeuittud, andsuch
:;j eci:,i conditions- as may. be indicated on the Permit.
rtu: owner .of this.,.property -is. L 4
'hp,t-er,c. --- ,,,,,..„../'
P.G. AJJreua • 'Pu1.(571-7%7,2'6K
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Property Location: 0 4l�L ft_g/
Tax Map No. /(
. Street i.ue:lher� or buildiny to number
:uLdivtlion name (if applicable) .�
I'IIL PERSON RESPONSIBLE FOR SUPERVISION OF �� ;
WORK AS 'REGARDS BUILDING:CODES IS:
r .une P.O. Addresa �. Tel. No.
•
Limo ,Uf /a1 r�
Installer • a44X.�C.�• �1,66_4ddreeu/1 d� 'f. F ,G� ,� Tel ��.1-7-39, 21..,Ina uI plumber a . / (-C Addraau k % ,,- ' •• k 3
i' Tel. i G lam_ .
:,uu of uriuon 'fr Ge Addreea et - tc. . C , Tel. /t /c h
:GUILE HOME INFORMATION • ZONING INFORMATION: -.
I h w Home Placement 4 A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
-' drawn reasonably to scale and attached hereto,
:enlacing existing. Home- • ahowin clearly y and distinctly all buildings,
:iz.c__gf new Nome / ft =X ` fft., ` whether eixisting or proposed and indicates all.
—� '::setback diweinsions from property ,line:e: Give ..
:ingle u . le • Double' wide • street and number or lot nuaeber and indicate
o. of rooms (excluding baths) *-whether interior or corner lot. Show location
' .*-of water supply and location and configuration
:o. of bedrooms C . , . - ' '._• ' of septic-disposal area,.
;o. of bathrooms •
` • COMPLETE INFORMATION REQUIRED BELOW.
'ireplace?)AA3 -Wood stove? } • Size of property 66 . • ft X--,Z t ft.
oundation style and size: • • Existing building(s) Size /y� ft X_1& ft.
iors- No.of : Size- -• ft x ft. '• kxiating. building (s) Uue
Depth below grade ' ft. .
GUNDATION - Footing size /�s� " X N.-. , Proposed- building, disLancu from property. line -
•. Front yard C ' 'f t'Rear yard .3 19- It
all material , Side yards _ -ft and 6q ft
all thickness Height ft. , If on corner, setback from side street tt •
oral •depth below grade ft. •. • OCCUPANCY INFORMATION •
• .
rade to Home floor level ft. - , PRIMARY BUILDING -
'.. , . One family dwelling
r . - Two family .dwelling '
roposed date of placement-A- /,3 r/ 9/ • Multiple dwelling / Number of units
p r o x. Value. of Home $ l Q/fi• o.'jr. • ..Permanent occupancy
. 'transient occupancy
a ter supply - Well - Municipal L • • Business '
N
. • Industrial
.ptic Permit requir • Other
• If addition, what will use be?
JRTHER INFORMATION REQUESTED •
• ACCESSORY BUILDiNC- -
v THE REVERSE SIDE OF TH 1 S SHEET.► Detached garage/one ,car/ two car/ ' _ car
• Attached ,garage/one car/ two car/ car
• Private storage building
• Other
• •
Form MII P 5/06 mc]-vl
APPLICATION FOR MOBILE HOME PERMIT, . (CONTINUED)
51:ate,''o1"U-.-New York Division of Housing and Community Renewal
INS;IG� IA; •' OF°; APP OVAL OF THE STATE BUILDING CODE
. INS.I;GN.IA ' SERIAL' NUMBER
NAME OF MANUFACTURER &4/471"-- "
PLAN APPROVAL NUMBER •
• MODEL OR COMPONENT DESIGNATION C /'1( ./-• PL-7
•
MANUFACTURER 'S. SERIAL NUMBER •
• DATE OF MANUFACTURE `/L / /9 •
�
All the above -information is to be found on a plate or sticker which
ou ld be affixed to the Mobil home. Coinptete..above with that 'information.
A • 4 4 ' 4 4 44 4 4 4 ., 4 4 4 4 4 4-..A A •4 • A 4 - 4 4 A 4 4 4. 4 4 4 4 4 4 A .A
'own of Qucenabury
'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 .anti
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
uchorized by the owner. - •
Signature.__X.��--
Chimer, •ow 's ent rcraze ,c tractor
• • • • • • • •'.•: * •. • • • * • * * • • • • • • • • •• • • • • • • '• • • • -• • • • • • •- ••
;PECIAL CONDITIONS OF THE PERMIT:
iE)Ck.5-c-mo aztr,g--
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YOU ARE HEREBY REQUESTED TO
INSPECT AND ISSUE CERTIFICATES
FOR THE FOLLOWING ELECTRICAL
EQUIPMENT TO BE INSTALLED BY
THE UNDERSIGNED _ r
TEMP.k DATE '�� _ % q 6
CRY OR V LAGE TOWNSHIP COUNTY
l
STREET.ND NO.OR ROAD / f �J J// t POLE NUMBER
r'\ (/_. / -t-.1':`L C^z i (-e ,�-(!--% ///.l,(-ye' ;?(_/
BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? ✓✓✓ SECTION BLOCK LOT
CUPANT'S NAME / r .. �' . UILDING OCCUPANCY /� �! .
/; ,1--/:0' L.:.L/,-- C /1i� 27:�/.�-d�Gv-- (1- . )C1_`i.!-%L, —✓."-�r--5,r-ee --,.�N."l/c --1/-C.-lam ,�''
OWNERS NAME DAD R�SS HOME TELEPH(E NUMBER
P ' / r
RENT SUPPLIP/BY JJ R THEIR / OFFICE WORK TELEPHONE NUMBER
B ILDING IS /ram//
NEW L� OLD❑ WORK IS NEW li./...."' 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
Lion 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.
REMA S:LIST OTJ-IER ELECTRICA DEV CE NOT SET FORTH ABOVE.
Mgr) /7 7-1 (// . ///,«,t
/tit r'% -1Ii fi," . -1(% _,/ d— -e.
THIS APPLICATION IS4'NTENDED TO COVER THgABOVE-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 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) UST T E TER A f NUMBERS
AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
•
PRINT NAME AND ADDRESS
j�, NAME,CT APPLICANT / i DATEOF AP LIIgATION SIG ATURE OF PLIC, T (z.
N 4-1':6�-A! .1/`t/ ta'ltR.y' �1/L. f�-2'�'^'t,�� `5 ��/ / X � '�%(�,���/ 1, 16��GG'�c t- ?.�'
ST ET/, DR S„ . 1,/ / �l /. T EEHONEJNO. ,i
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LLj'j'�O7_,_,,,,z,
R POFQFFJC�(' �/ •i�IP-ODE LICENSE NO.WHEN APPLIC,4 L
l/�f— v!(/ C 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-IF NFW YORK BOARD OF FIRE UNDERWRITERS •
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DALOm _ _ .l
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1' • THE NEW YORK BOARD. OF FIRE UNDERWRITERS PACE 1. o
20'1 f;20/ BUREAU OF ELECTRICITY
�; I 41 STATE STREET,ALBANY,NEW YORK 12207 •
�; Date ,TUNE 11., 1991. Application, .onfi •.?? 1,`.I S-t ijhi7 ' 41.:1;'21 0
kit'i, THIS CERTIFIES THAT PERMIT' ,?': 91--: ''i.1 o`
only the electrical equipment as described below and introduced by t 'co t named on the above application number in the premises of la i
,C1 --)A /¢.3 r. 1131 �J VNun'. z.. S"_r L, S.' l. ; 4r':,P
C � 1:. srr sr,
in the following location; ❑ Basement ❑ e1st Fl. ❑ 2nd Fl. OUT Section Block Lot ' :, so�-
IX: was examined on M t T1;' 2 9,19 91 and found to be in compliance with the requirements of this Board. 1,,41 FIXTURE I FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS g
OUTLETS ECEPTACLES SWITCHES INCANDESCENT-FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
i to
f.
!' DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS o
SYSTEMS
: AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. . AMT. AMP. AMT. AMPS. TRANS. ANT. H.P. NO.OF FEET AMT. WATTS ICJ
t.
�, L
�; SERVICE DISCONNECT NO.OF • 5 E R- V I C E •
r AMT. AMP. TYPE TER 1,B'2W 1,a 3W 3 3W 3 0 4W NO.OPER�COND. OF CC.COND.. NO.OF HI-LEG OF'HI-'LEG NO.OF NEUTRALS OF NEUGRAL •�
if, OTHER APPARATUS:
P_M1ET,B,C`ARl110:1.--2 (JR. .1_00 .
1
O;
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n
(......
1}(:rrC! 'i'fI l !iiJ RA Y '.`' `_' _ Ul z:
m BRANCH MANAGER r^"�
PS. R f . 9 3i D_n, '• Lx1
' FORT • r
: •e�0 rD tfD. NY, .1. 828 )0 o .
; Per
`
1:,; 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. '.
-
ntY•CY•i'4YYtYYeY-4YYer iAfYA 'iAY16-<-4(Y‘7•41-4-iei- - ie-4Y-?.?•i YYe"i-,--4i 4—ci sY• ri rl n 15 ® ® 0 0 n ® rfinnifilinir ® ii y;r r-;•::A; }.
• • COPY FOR BUILDING DEPARTMENT• . THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
N
TORNOff QUEENSBUR�� ?
1■A: A 531 BAY ROAD
:.` j.; QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
FINAL INSPECTICC
REQUEST FOR INSPECTION RECEIVED
•
LOCATION] „�r ,.3- —rnr� ���- �
DATE 5�Y/*/ PERMIT#
TYPE OF STRUCTURE ` '�, 7j,67
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCT)RE)
FOOTING FOUNDATION BACKFVLL _FRA• NG
ROUGH PLUMBING FINAL ELECTRICAL •S PTIC
INSULATION WOODSTOVE/FIREPLACE
SITE PLAN/VARIANCE REQUIREMENTS YES NO
REMARKS d
�7
:r V
A PROVAL
N/�A YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION
PLUMBING VENT
ROOFING if
SIDING ;t
DECK/PORCH/STEPS/RAILINGS
';1 RELIEF VALVES 1
}FURNACE/HOT WATER OPERATING
BASEMENT I-nSULSFWBUC WQRA
INTERIOR TRIM/PRIVACY DOORS 7/
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT; :
OTHER FLOORS SWEEPABLE ; .
OTHER FLOORS CARPETED !'I
STAIR CLEARANCE/RAILINGS/
HANDICAPPED ACCESS 1r;
)"SMOKE DETECTORS
BATHROOM FANS/WHOLEHOUS'E !:FANS
ALL PLUMBING .FIXTURES OPERATING •‹
GARAGE FIRE - RQOF_LN_G /
-NOR CtOS•tRS ' i f.
OTHER FIR--St
FIRE/DF IS-E W n i /'
-DtJMPSTER
FINAL ELECTRICAL /
OK TO ISSUE C/O OR' C/C
COMMENTS:
•
(1_J
ARRIVE /O; 1 0
DEPARTJO
own, o r�eenJ tr BUILDING & CODES DEPT,
THE PLANS SUBMITTED HAVE BEEN REVIEWED AND
HAVE BEEN FOUND TO LACK SUFFICIENT DETAIL
FOR PROPER PLAN REVIEW.
WE HAVE ISSUED THIS PERMIT WITH THE
FOLLOWING STIPULATIONS :
1 . THE WORK WILL BE INSPECTED AND MUST CONFORM
TO ALL PROVISIONS OF PREVAILING CODES .
2 . IF DEFICIENCIES ARE FOUND THEY MUST BE COR-
RECTED BEFORE WORK CONTINUES .
3 . FAILURE TO COMPLY WILL RESULT IN REVOCATION
OF THE BUILDING PERMIT
144.1.)...
Code Enforficer
5/,
Da t e
R'1, 2R8
Building Permit #
COMMENTS:
io PLPIAJ S � eviAcrrt-ee F� rz t��,v°,aT ov 13 cc clz la°
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geed en oar loilmionimime
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net be atelneeti ast
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7.4 14 R,2 BR,2 BATH 1 1 ��
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"ASTER O�,••• "� 1 ,I UTILIZY wN � � YI��IC i`�jl�'
,r) • KITCHEN. �' rt��'ti'
j BATH ...7/""
_ /' � � :�'. LIVING ROOM DINING AREA � i '•t
_.���/// \ R.BEDROOM.1 r
SWIM
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I`:"`SMO»'i�1■ • •/-; i• ''r--:.'•�= y* cw.c• MAIN • "' fl.
�� '' cwc••� 7"
BATH 1.
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PLAN NO.CIA-SIS
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A.--t-ez ,5-7:_c--#1.--i,t.2741,—,e.-
MAY 14 1991 ,q cz_z_,L,,--4_ .,,,„7, 17- -
BLDG. & CODE DEPT.
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TOWN OF -QUEENSBURY
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' REVIEWED BY dit.,
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FILE COPY 7P 1
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