1991-354 {
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CERTIFICATE OF OCCUPANCY:..
TOWN OF QUEENSBURY
WARREN COUNTY,. NEW YORK
Date 01//1/2 D 1 19 q
This is to certify that work requested to be done as shown by Permit No. 91-354
has been completed.
This structure may be occupied as a simile family mobile home
Location Lot 23 Homestead Village
Elaine E. Jones and Paulette M. Dow
Owner
By Order Town Board
TOWN. OF QUEENSBURY
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• Director of Bldg. & Code Enforcement
BUILDING PERMIT h
TOWN OF QUEENSBURY
No. 91-354
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Elaine C. Jones & Paulette M_ Dow
OWNER of property located at Lot 23 Homestead Village Street, Road or Ave.
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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 L,
Mendal/Lavin
Luzerne Rd
Queensbury NY 12R04
2. CONTRACTOR or BUILDER'S Name -�
Lamplighter Homes
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3. CONTRACTOR or BUILDER'S Address
RD#2 Saratoga Rd c
Fort Edward NY 12828 1E
4. ARCHITECT'S Name •
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5. ARCHITECT'S Address
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6. TYPE of Construction- (Please indicate by X) r—
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( I Wood Frame ( ) Masonry ( I Steel ( )
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7. PLANS and Specifications
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No. 14'x60' Mobile home as per plot plan, specifications and application.
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8. Proposed Use O.
Single fmaily mobile home
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$ 23_00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 30 19 q2
(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.) tT
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Dated at the Town of Queensbury this nth Day,.of May 19 qj c
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SIGNED BY ( c / i�% ��l for the Town of Queensbury
Buildirig andYLoning Inspector
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c� TO BE COMPLETED BY I]LDG. DEPT. T WN OF QUEENSSUR .
/uwn ui QueeniGurir Permit
No. RECEIVED
BUILDING enu ZONING DEPARTMENT rmit Issued I9
Bay Lind Heviland Road, R.D. 1 Box 08 Zoning •
Designs • 19 MAY 2 81991
OuuensDury, Now York 12801 Zoning Designation— --
Variance No..
Site Plan Review .o. B DG. COIa ,Dl=I3�
APPLICATION FOR Appr• e /; / // Xi •
MOBILE HOME .
PUILDING AND ZONING PERMIT '013- V.s r * r . • w • • . • t * * •, s . • • r . • -e M * • •. • w . • * • • • w w::•.
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:CL _,a ..� HZ4.4,0—
P.O. Address Luzerne Rd., Queensbury. `
Tel.
Property Location: Lot #23, Homestead Village, Queensbury, NY
Street :;u:uber or building lot number. •
Tax Map No. P42.!/ ��
Subdivision name (if 'applicable) Homestead Village
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
Lanplighter. Homes
Name . P.O. Address •
• Tel. No.
Name of Installer Shores Mobile HomeaLddress Cambridge, NY
Name u1' plumber ,I Te1.518-677-5997
Address Tel.
Name of :bison N/A Address
Tel._
MOBILE HOME INFORMATION: . . ZONING' INFORMATION:
New Home Placement X . ' A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
Replacing existing Home » drawn reasonably to scale and attached hereto,
showing clearly and distinctly all buildings,
Size of new Home 14 ft X 60 ft . • . ' whether existing or proposed and indicate all _
1' -set-1) ck- iiwens]ode from property lines. Give
Sincj"le w`• -ie • -X Double wide ' street and number or lot number and indicate
�j . e whether interior or corner lot. Show location
No. of rooms (excluding baths) -
No. of bedrooms 2 • of water supply and location and configuration
1 ' of septic disposal area.
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No. of bathrooms . COMPLETE INFORMATION REQUIRED BELOW.
Fireplace? No Wood stove? No ' Size of property - 6 s) ft X �d-6 ft.
Foundation style and size: ' Existing buildings) Size ft X ft.
Piers- No.of Size- • ft x ft. " Existing building(s) Use ' •—
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Depth below grade ft.
FOUNDATION - Footing size " X * Proposed building, distance from property line
. Front yard 4,3 ft Rear yard, .,7 7 ft
Wall material . Side yards ft and Vs ft
Wall thickness " Height ft. • If on corner, setback from side street ft •
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Total depth below grade ft. OCCUPANCY INFORMATION
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Grade to Home floor level ft. . PRIMARY BUILDING -
. x One family dwelling
. Two family dwelling •
Proposed date of placement 5 / 30/ 91 . Multiple dwelling / Number of units
Aprox. Vales. of Home $ 27,100.00 . Permanent occupancy
• 'Transient occupancy .
Water supply - Well Municipal x Business
. Industrial •
Septic Permit required? Existing , other
. If addition, what will use be?
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FURTHER INFORMATION REQUESTED
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' ACCFSSORY. BUILDING-
ON THE REVERSE SIDE OF THIS SHEET.. Detached garage/one car/ two car/ car
* Attached. garage/one car/ two car/-----g car
' Private storage building
' Other
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Form MIIP 5/66 and-vl
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APPLICAT:I'ON FOR MOBILE HOME PERMIT, (CONTINUED)
State of New York Division of Housing and Community Renewal
INSIGNIA OF APPKOVAL OF THE STATE BUILDING CODE
1 . INSIGNIA SERIAL NUMBER / 1, 3()
2 . NAME OF MANUFACTURER Colony
3 . PLAN APPROVAL NUMBER poz S.. •
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4 . MODEL OR COMPONENT DESIGNATION
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5 . MANUFACTURER' S. SERIAL NUMBER
6 . DATE OF MANUFACTURE V/7 .9 d
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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.
A A A A A A A + ''A A 4 4 4 4 4 4 4 4 4 •4 4 '4 . 4 ' 4 4 4 4 4 4 4 4 A A AA 4 4 4
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Town of QueenSbury
County 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
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 r o .'�+.--d_ G'..�k—s 9 1- y,
..orlt.�,�.d=�:ith i7C-fC:si or—noti—and--i:'riat--6-trcFti--wc,rn is --
authorized by the owner.
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Signature i �1►� _
' Owner •o •s a wit a f• tec con rac or � � �
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• • • * • * •• • • • • • * • * * * * • • •• • • • • • • • • • • • • • • • • • • • • • • • • '•
SPECIAL CONDITIONS OF THE PERMIT:
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. • • By •
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YOU ARE HEREBY REQUESTED TO
INSPECT`AND ISSUE CERTIFICATES
FOR THE FOLLOWING ELECTRICAL
EQUIPMENT TO BE INSTALLED BY
' THE UNDERSIGNED
. TEMP.p DATE (r•?/ - 0 ` �'
CITY OR VILLAGE • TOWNSHIP I COUNTY
arzEn
STREET AND NO.OR ROAD �,�^.,� �T - T.� - - YY POLE NUMBER
lot 23 Har stead Village, .use Road • .. ..
BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? . SECTION BLOCK LOT
OCCUPANTS NAME BUILDING OCCUPANCY
Elaine E. Jox2.s & Paulette N. Dow Single Family •
OWNERS
lNNA�1MEEE AND ADDRESS HOME
TELEPHONE NUMBER
7-809
CURRENT SUPPLIED BY FROM THEIR OFFICE �ORKK TELEPHONE NUMBER -
Niagara Mohawk Glens Falls
BUILDING IS EX 'I Ty
NEW L OLD❑ WORK IS NEW ADDmONAL❑ DEFECTS REMOVED❑
LIST BELOW ALL EQUIPMENT WHICH.YOU INSTALLED
r; 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- -tc '
il
• SIDE
SUB- ,
• BASE
BASE- MODULAR HOVE ,
MENT •
1st
FL
2nd II
FL.
3rd • -
FL.
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REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE. : •
- 100 AMP DRD 4 WIRE
110 A P NAnat.herprcof disconnect
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.
SEE OF MAINS - FEEDERS ELECTRIC SIGNS/LAMPS TOTAL WATTS
.1
CHARACTER OF WORK ❑ EXPOSED GAS TUBE SIGN/TRANSFORMERS OF • VA
❑ CONCEALED
DATE WORK TO BE STARTED DATE COMPLETED SEE OF SIGN(NUMBER) CAPACITY
SERVICE ENTERS BUILDING MANUFACTURER OF SIGN
,1
❑ OVERHEAD ❑ UNDERGROUND
DATE INSPECTION REQUESTED ON(OR AS NEAR AS POSSIBLE) MUST DENT E TER APNPUMANTS ►
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 A`'PLIc N_T
nrwri-hh Mirray/Tar 7 i car i r Hams 5/28/91 X /±,'v4. Y�Iii.L tdr..1..4-
STREET ADD SS ;, - TE [�/C�NE/rI/O. ^�/ `�`j
IT 7 LI ENSE NO. HEN-. ICA.r
CITY OR POST OFFICE ZIP CCODDE.
. L- Edward,, NY 12828
D 85 John Street E 41 State Street 0 570 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
I
THE NFW YORK BOARD OF FIRE.LUNDERWRITERS,
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• THE NEW : YORK BOARD. OF FIRE UNDERWRITERS PAGE 1 ,_.
- ;.-.
4129215 BUREAU OF ELECTRICITY - R.
41 STATE STREET,ALBANY,NEW YORK 12207
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Date MINE 14,1991 Application No. n-fileQ 7 059:391/91 A 053971 at
t 0 PERMIT NO 91-354 Nil
.., i THIS CERTIFIES THAT
--i only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
E.E.JONES/PAHLETTE R.DOW, LIJZERNE ROAD, HOMESTEAD VILLAGE, WEENaURY, N.Y. RD
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* in the following location; 0 Basement 0 1st Fl. 0 2nd Fl. OUT Section Block Lot 23
0 JUNE .05991
g was examined on ,1 • and found to be in compliance:with the requirements of this Board.
FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
(ZZERTES ECEPTACLESI SWITCHES
INCANDESCENT.FLUORESCENT OTHER AMT. • K.W. AMT K.W. AMT. K.W. AMT. K.W. AMT. H.P.cf, _ 171,
. • Z
',;': • .
"i. DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS kit
SYSTEMS rg
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
* . ,
N
E g
' SERVICE DISCONNECT NO.OF S . E ' R ,': V I C E rii
* . METER
c_ AMT. AMP. TYPE EQUIP. 1,6'2W 1,ff 3W 3 0 3W 3,H AW NO.045ChirCOND.
OF AdMND.. NO.OF HI-LEG op-ta NO.OF NEUTRALS
OfANEUTRAL
0 •
0 OTHER APPARATUS: N g
S 0 PANILBOARDS:1-2 CIR. LOG E
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0 LAMPLIGHTER HONES ,
DOROTHY HURRAY
RT.9 RD2 •
. BRANCH MANAGER
, FORT EDWF,RD, NY, inn • . 39 in I
• , Per KA r.7,•!-..E.
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. ,1! i
:LE -i•-?•i•Fei.-4-,-16i7-iii•v-iizrlei-le-iii••;&i•-i'ai--iiii- rie‘iiii-iii•-iai-iei-iai-iw'riiii---i-aii.l. rl lmn n ri n n n rl Ego n !!! r! ri NE r! n n Ego !!! NNE man
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COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
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�.. = . TOW OF QUEENSBURY
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDIP , INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED
NAME & V41P ( /o j,h .iI( f6D7,d
LOCATIONI %- h'it/4/l e d ii?!
DATE 5,./y/ PERMIT# 0-
TYPE OF STRUCTURE `f)( J/.
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFILL FRAMING.
ROUGH PLUiBING --FINAL-ELECTRICAL SEPTIC
INSULATION WOOUSTOVE/FIREPLACE
SITE PLAN/VARIANCE REQUIREMENTS YES NO
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REMARKS
APPROVAL j.
N/A YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION
PLUMBING VENT
ROOFING -
SIDING
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES
FURNACE/HOT WATER OPERATING
BASEMENT INSULATION/DUCTWORK
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS: i \`1
BATH/KITCHEN WATERTIGHT ,
OTHER FLOORS SWEKPABLE \
OTHER FLOORS CARPETED ti,
STAIR CLEARANCE/RAILINGS \
HANDICAPPED ACCESS
SMOKE DETECTORS ,
BATHROOM FANS/WOOLEHOUSE FANS '\
ALL PLUMBING .FI/XTURES OPERATING
GARAGE FIRE PR OFING
DOOR CLOSERS
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS
DUMPSTER
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C
COMMENTS: ,
C E- P14,6 g-a- I)'z, 2 j' PPGe7-/o.
ARRIVE i/r(('/
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DEPART Li7i �f% /',(i ..
J ' INSPECTOR
•` ' L TOWN OF QUEEMSBURY
531
`rj'f'y QUEENSBURY,BAY NEWRYAD YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTIO1 RECEIVED 49
Ctrlik0/ PALJ
LOCATION 1 F 9 Arnt-0,41(6-1
DATE (.„/#/97 PERMIT# 9/-35V
TYPE OF STRUCTURE
RECHECK CPO,L. / / t,(,0
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFILL. FRAMING
ROUGH PLRING FINAL ELECTRICAL_SEPTIC j.
INSULATION WOODSTOVE/FIREPLACE
SITE PLAN/VARIANCE REQUIREMENTS pl YES _ NO
REMARKS '
d APPROVAL //
N/A YES ,NO
CHIMNEY HEIGHT/LOCATION ('i' �P
B VENT/LOCATION
PLUMBING VENT
ROOFING ;R /
SIDING t
DECK/PORCH/STEPS/RAILINGS ; f X
RELIEF VALVES p /
FURNACE/HOT WATER OPERATING p t
BASEMENT INSULATION/DUCTWORK I) /
INTERIOR TRIM/PRIVACY DOORS V
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT /
OTHER FLOORS SWEEPABLE / i(
OTHER FLOORS CARPETED /
STAIR CLEARANCE/RAILINGS
HANDICAPPED ACCESS /
SMOKE DETECTORS /
BATHROOM FANS/WHOLEjWUSE FANS)
ALL PLUMBING .FIXTU�tES OPERATING
GARAGE FIRE PROOFING
DOOR CLOSERS //
OTHER FIRE SEPATION
FIRE/DEMISE WALLS
DUMPSTER
FINAL ELECTRICAL Q
OK TO ISSUE C/O OR C/C V
COMMENTS:,-,•
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ARRIVE kill)
DEPART /.; ' ) / /
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TOWN OF QUEENS-BUM
RECEIVED
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MAY 2 8 1991
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BLDG. & CODE DEPT.
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• Factory Cra f Led Homes
P.O. Box 310
. Shppenville, PA 16254
Ph)ne: (814) 226-9590
TOWN OF QUEENSBURV"
RECEWFD
�__�Y--� I � MAY 2 81991
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BLDG. & CODE DEPT.
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