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1991-411 CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN ...COUNTY, NEW YORK Date `11,' 1iJ d' 19 7/ 5(ci -- This is to certify that work reqpested to be done as shown by Permit No. 91m41 1 has been completed. This structure may be occupied as a Mobile Home Location Ii1 i Boi s Avenue Owner Lawrence Fl ewel l i ng. Jr. By Order Town Board TOWN OF QUEENSBURY i6/1, 74//771 .,7 Director of Bldg. & Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY No 91-411 WARREN COUNTY, NEW YORK O PERMISSION is hereby granted to Lawrence Flewel l ing Jr. I w OWNER of property located at Illinois Ave. 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. -I9 rD 1. OWNER'S Address is 173 Homestead Village Queen sbury, NY Len 2. CONTRACTOR or BUILDER'S Name Fred Smith rD 3. CONTRACTOR or BUILDER'S Address fD Box 300 Vermont Ave. 4. ARCHITECT'S Name O 5. ARCHITECT'S Address tD 0 6. TYPE of Construction—(Please indicate by X) r ( )Wood Frame ( ) Masonry ( )Steel ( ) CD O 7. PLANS and Specifications co No. 14' x 70' 1986 Mobile Home as per plot plan specifications and application 8. Proposed Use Mobile Home $ 6Q_00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 17. 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 thisn 17th Day of June 19 91 SIGNED BY C\; 1" tyv� for the Town of Queensbury Building nd Zoning Insp r • n • TO DE COMPLETED BY BLDG. DEPT. �(O�1 ICJ • _ wn o f QuPBnAl ur Application No. vv Permit Issued • 19 BUILDING and ZONING DEPARTMENT • Permit •Expires 19 Bay and Haviland Road, R.D. 1 Box-98 Zoning Designation 10 WWI.OF •!E NSDU,I Queensbury, New York 12801 Variance No.. ASCE—TIED Site Plan Review No. APPLICATION FOR Ap oved b : q/—tf// . si�Iilli 1s -. MOBILE HOME ?' , v 4,� q . D ODE PUILDI-NG AND ZONING PERMIT DEPT. it * iF it �F ii • i1 * i IF F 11 i IM li • 11 i ii iF iF it::�F 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 maybe indicated- on'the Permit. The owner of this. property is:� ` ir.. Re JJ,�� 0 , P.U. Address 073 Ron eel/s cY Ike. / Qdp1U)tSkat"' . C1. A4 7� /.2�� Tel. 7 .�ci Property. Location: _,�,Lri1Oil Ive Tax Map No. Street humber.or building lot number /=?y— 3-7 Subdivision name (if applicable) TILE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS S BUILDING CODES IS: b gal A x0 ( rii u� '71�';It Name Y.O. Address - Tel. No. Name of Installer ,0."'"7 ,A, F„ Address Tel. Name of plumber Th i(/ , Address Tel. Naw of mason . ( / 4'1 V Address Tel. MOBILE HOME INFORMATION: * . ZONING INFORMATION: New home Placement k . * A PLOT PLAN MUST BE PREPARED AND SUBMITTED, drawn reasonably to scale and attached hereto, • Replacing existing Home * showing clearly and distinctly all buildings, Size of new Home / ft X IV ft T l� * whether existing or proposed and indicate all * set-back dimensions from property lines. Give Single w 'e • K Double wide - * street and number or lot number and indicate. * whether interior or corner lot. Show location No. of rooms (excluding baths) e,7 • _* of water supply- and location and configuration • No. of bedrooms • * of septic disposal area• / * - No. of bathrooms ..�`` * COMPLETE INFORMATION REQUIRED BELOW. Fireplace? I/6 Wood stove? N� * Size of property 4 20 ft x /OO. ft. Foundation- style and size: 5/0 6 * Existing building(s) Size ft X ft. Pier-s.. No.of / Size-/ /ft x 7d ft. Existing building(s) Use ,FF'.N6 -* Depth below grade . FOUNDATION - Footing size " X „ » Proposed building, distance from property line .* Front yard 3r ft Rear yar/ 1 � ft Wall material * Side yards /O ft and !7�. ft Wall thickness " Height ft. * If on corner, setback from side street _ ft • * OCCUPANCY I NFORMAT ION Total depth below grade ft. * Grade to Home floor level ft. * _ BUILDING - * * * .* * * * * * * * * * * * * * * * * * Onee family dwelling * Two family dwelling Proposed date of placement e / v5G/ %� * Multiple dwelling / Number of units • Aprox. Value. of Home $c2(4O00. 00 * Permanent occupancy * Transient occupancy Water supply - Well Municipal - * Business * Industrial • Septic Permit required? '/�� * 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 .md-vl APPLICATION FOR MOBILE HOME PERMIT, (CONTINUED) State of New York Division of Housing and Community Renewal INSIGNIA OF APPtOVAL OF THE STATE BUILDING. CODE 1 . INSIGNIA SERIAL NUMBER 2 . NAME OF MANUFACTURER f o�101a- // e Inc, 3 . PLAN APPROVAL NUMBER RA A J `7O 4 . MODEL OR COMPONENT DESIGNATION 76 fe/� Fk —RA ES' 1a er'- • 5 . MANUFACTURER ' S SERIAL NUMBER- j1V,97 4©97e 6. DATE OF MANUFACTURE j/-/3-'1:-6 • • • • 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 k *_* * * * ** * * * Town of Queensbury AFFIDAVIT 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. , . f Signature_ _Owner, owner' agent,arcnitect,contractor • * * * * * * * * * * * * * * * * * * * • * * * * * * * * * * * * * * * •* * * * * * * * * * •* SPECIAL CONDITIONS OF THE PERMIT: • By TOWN OF QUEENSI3URY -irti�''"` APPLICATION .FOR '"Y- > ,,', ; SEPTIC DISPOSAL PERMIT DATE 6/0 7 LOCATION OF PROPERTY FOR INSTALLATION j74,6/.5 4%. Owner's Name:// I(/,,(, (l P4(7// f Telephone: WK35.4;?// Address: /7 j M.))1)‘?,517))01 (%// Installer's Name: 6dc'27/i Telephone: �1 P c ‘ • Number of bedrooms (residential only) 3 Total daily flow (compute (d 150 gal per bedroom) • •• L5- 4 Topography: Circle one: lat Rolling Steep Slope % of Slope Soil Nature: Circle one : _O Loam Clay Other /Depth: Feet Ground Water: At what depth? Feet Bedrock or Impervious Material: At what depth? Feet Percolation test: Circle one: not required required rate min. inch. Domestic water supply: circle one: Municipal �11 Other If domestic water supply is a well: Separation: Water supply from septic absorption feet PROPOSED SYSTEM: Septic Tank /ii' O gal. (minimum size: 1,000 gal.) TILE FIELD: Each Trench feet/Total system length • feet SEEPAGE PIT(S): Number of / Size each 6 feet by r( feet Size of stone to be used #1/43 /Depth or Thickness feet ************************* I have read the regulation on the reverse side of this sheet cind agree to abide by these and all requirements of the Town of Queensbury Sanit y ewag Disposal Ordinance. SIGNATURE F I ESPONSIBLE PERSON: ,f DATE: o �� �/ OVER Septic System Inspections: A. All applications for septic system installation, alteration or repair, as required by the Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Building Department at least 24 hours before start of construction and shall include a plot plan showing: 1.) the proposed location of the system 2.) location and distance to lot lines 3.) location and distance to structures • 4.) location and distance to any water supply 5.) size and dimensions of all tanks, distribution boxes, tile fields and/or drywells B. No system shall be covered before inspection and approval by the Building Inspector. Failure to comply with this requirement may result in the uncovering of the system by the installer and a fine of up to $250.00. C. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installa— tion, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury, New York 12804 Remarks : • °''�w�� MIDDLE DEPARTMENT INSPECTION AGENCY, INC. p 4 i �* National Headquarters 1337 West Chester Pike,West Chester, PA 19380 , APPLICANT COMPLETES THIS SECTION Date:,!///f City, Town or Township • �'_ , r •J .l'- ' /• County r - ., < <=' •- State/A/l•`, J . Location/Address _ __(If Located in Rural Area - Please Attach Directions) Pole # Owner / ( ' • / i _ • /// . ; ; . Permit # . ': ,, . . /.•!,./'• /7;:, 7 tcc Building: New Old Occupied As -' 9 Occupant ', '/f^J ` Work Area in Building (Floor #,etc.): , App. for: Wiring n Service®- or: Ready for Inspection: j% '' 7i',/ Fee Remitted-$ Cash n Check n M.O. n NJake 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 Water Heater Air Conditioner Dryer • Pump Receptacles Number of Fixtures Oven Garbage Disposal Wiring and Controls for Burner Amp. Receptacles Fractional H.P. Vent Fans ,v Other Equipment: MOTORS H.P. 1/201/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 '11/z 2 3 5 7'/2 10 15 20 25 30 40 50 75 100 Mark Number of Each Size Applicant's �/ Signature cam/'cc_ -76L``C'660:`f `� ' License # Permit # T/A J Utility: • Applicant's Address: >'i - ll / (NAME) (OFFICE LOCATION) (City) .r . , 7 (State) 4 / s� / . (Zip) /_ -,/ Service Request # Phone # - - / Electrician: MDIA USE ONLY DATE RECEIVED: DATE INSPECTED: • Correct Location: Same as Above or: Red Notice Label n f' Rough Wiring Outlets Surface Unit • Oven Switches Range Garbage Disposal Receptacles 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 V.1/8 1/6 1/4 1/3 1/2 3/4 1 1'/2 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 CO RECT FEE PAID 1 RW Progress: .Inc. i LKD❑ Contractor ❑ CFT Violation: Work Comp.❑ Inc. ❑ CASH ❑ n L/A Owner Fee CHK # 7 L/A • Due MO # n IPA Municipal INV # Date: _ - Other Side❑ Utility Applicant ❑Owner Cut in Card n Temp # Date INSPECTORS SIGNATURE n Final # Date APPLICATION FORM NO.250 EL 11/89 c.., CIA0(\f„ ' 1 ()II) . _Down of Q ,.,, BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME t P u I I 1 , Cc Uo r erne Q LOCATION 1 l (.\Cj S ,�I� DATE ( / PERMIT NO. q / —?"// SOIL TYPE - Sandi- Loam - Clay - Percolation Test/ Required? YES - NO , Percolation rats' - Min/Inch _ TYPE of SYSTEM: Absorption fie]: , total length Length of each trench„'f Depth of trenc es . ` ik Size of gravel: ,j SEEPAGE PITS{Nuinberfof) 2 Size- ft. 51ft. Gravel size PIPING: j Size Type Bldg. to tank !` . Tank to dist. )box Dist. box to fiiheld/pit Openings sealed? YES NO Partial il LOCATION/SEPARATIONS: Foundation to tank ft. Foundation toabsorption _ f . Absorption to lot line f . — Separation/of pits ft LO :_ION OF SYSTEM ON PROPERTY circle one) Front Rar - + eft side - Right side. - ''I' NTS e--ol . �, 2U(OcSLL/ • . ptipe60--/-6\ . • SYSTEM USE APPROVED S NO & L B ilding In ector 01/86 and vl o,•i TOWN OF QUEENSBURY (M) w 531 &AY, ROAD QUEENSBURY, NEWYIAK 12804 TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT FINAL INSPECTION REQUEST FOR INSPECTION RECEIVED 7/S/i NAME �-1 e ; n , 1-c �t�, , QANcQ LOCATION j(I!ram G"-I 0(-9f DATE r/`C4 19' PERMIT# / '11/ ( TYPE OF STRUCTURE ,) )e, griMe FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE) ,/FOOTING FOUNDATION BACKFILL FRAMING ROUGH PLUMBING FINAL ELECTRICAL SEPTIC INSULATION WOO�STOVE/FIREPLACE SITE PLAN/VARIANCE REQUIREMENTS YES _ NO , NeQ Q.0 C•1 eG c'nCt..0 REMARKS % APPROVAL N/A YES NO CHIMNEY HEIGHT/LOCATION ,, B VENT/LOCATION \ PLUMBING VENT N ; ROOFING SIDING DECK/PORCH/STEPS/RAILINGS RELIEF VALVES FURNACE/HOT WATER OPERATING BASEMENT INSULATION/DUCTWORK INTERIOR TRIM/PRI:VACY DOORS, FINISH FLOORS: BATH/KITCHEN WATERTIGHT OTHER FLOORS SWEEPABLE OTHER FLOORS/ CARPETED STAIR CLEARANCE/RAILINGS HANDICAPPED ACCESS i, SMOKE DETECTORS ;S 4, BATHROOM FANS/WHOLEHOUSE FANS ALL PLUMBING .FIXTURES OPERATING GARAGE FIRE PROOFING DOOR CLOSERS OTHER FIRE SEPARATION FIRE/DEMISE WALLS DUMPSTER FINAL ELECTRICAL OK TO ISSUE C/O OR C/C COMMENTS: IL` NO 0 2_.4_,2, 5-alo46, OG i6 2nA UALC_ N 3 i/4-L -10 aj cc'ii-1v- 60 1),44s, ARRIVE /0,_'U6 DEPART (D;/i �� ��- ELECTRICAL INSPECTIONS DUPLICATE MUNICIPAL RECORD Permit No. 91-41/f Owner I's f FL...6 ouG Occupant _ - Locatiioono) ). eL/L1'l//6 �5 -1 �% �- t-1-4� ,`1 tJ_-B K /L Street Town or City State Installation as itemized on reverse side has been visually inspected pursuant to applicable codes. Installed by �, a, No. (0 66 Date �'� —Il (! GK Arapec` ctor MIDDLE DEPARTMENT INSPECTION AGENCY,INC. FORM NO.18 EL. 1337 West Chester Pike,West Chester,PA 19380 ROUGH WIRING OUTLETS H.P.AIR CONDITIONER OUTLETS WIRING &CONTROLS FOR BURNER RECEPTACLES H.P.PUMP FIXTURES - K.W.OVEN O AMP.SERVICE EQUIPMENT H.P.GARBAGE DISPOSAL UNIT C ' ® AMP.SERVICE CONDUCTORS K.W. DISHWASHER K.W.SURFACE UNIT K.W. DRYER K.W.RANGE AMP. RECEPTACLE K.W.WATER HEATER FRAC. H.P.VENT FANS �Ll 6•0//L" / OW C s6-4!/les E Ail.)‹. MOTORS H.P. I/20 1/12 1/10 '/6 '/6 '/ '% 1/2 ''A 1 1'/: 2 3 5 71 10 15 20 25 30. 40 50 75 100 MARK NUMBER OF EACH SIZE APPARATUS • _town of Queeniur, . • BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME rtf(,u 121 L.I4/6 LOCATION I L L I pots Acr& DATE � ?`I PERMIT NO. 9, SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM , Absorption field, total length Length of each trench Depth of trenches _ Size of gravel_ , <' _ SEEPAGE P ITS4Nuinbr ,'of) • Size- ft. X _'9, lit. Gravel size , PIPING: C Size Type Bldg. to tank Tank to dist. box ' , Dist. box to field/pit Openings sealed? AYES NO Partial LOCATION/SEPARATIONS: �h Foundation to tar + A ft. Foundation to absorption _ ft. Absorption to lot,7 line r,, ft. Separation of pits , " ft. LOCATION OF SYSTEM ON PROPERTY(circle one) Front - Rear - Lpft side - 'Right side - COMMENTS: F i1F-L— A0006 Pt-C_S'Egri(--TT-AWE-I-LW& ILTO /S©g_p Tic)Af 1-1-12-ER • SYSTEM USE APPROVED Y. NO B ,ilding Infector 01/86 and vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPOR L REQUEST FOR INSPECTION ,RECEIVED NAME — _ e f.l ` U LOCATION 1 (No DATE L C PERMIT I CI I LP/ TYPE OF TRUCTURE ) C� We RECHECK APPROVED N/A YES NO ;)KFOOTINGS/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. MATERIALS FOR THIS PURPOSE ON SITE FOUNDATION/WALL POUR REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFING E BACKFILL APPROVAL I ROUGH PLUMBING PLUMBING VENT/VENTS IN PLACE I PLUMBING UNDER SLAB FRAMING: I' JACK STUDS/HEADERS BRACING/BRIDGING r JOIST HANGERS r, JACK POSTS/MAIN BEAM , FIRESTOPPING WALLS CEILING FIREWALLS ',; HEATING ROUGH-IN INSULATION: FOUNDATION WALLS INTERIOR R- FOUNDATION WALLS EXTERIOR R- FLOORS R- WALLS R- CEILING R- DUCT WORK OR PIPING' IN UNHEATED SPACES ,` REMARKS � i u 5 LLB J Pi-z Pto ept-4L gtiJ& P°UczcA . C 1 • ARRIVE 31 75-6 DEPART ;Do ! J I NS PEC R • TRAILER BODY. _ ! TRAILER FRAME. TRAILER I BEAM WOOD BLOCKING * CEMENT BLOCKS 4"THTC% SL4R l ' FINISH GRADE -_--..,, r d • REZNFORC MENT ROD __ 6-6-10 WIRE MESH REINFORCEMENT ROD AND MESH AS PER CONDITIONS SLAB TO RUN FULL LENGTH OF THE TRAILER AS SHOWN • 1 ' -f\ ...........• -Li i looks , ue - . 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