1991-657 ....-
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--- tERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBUity
WARREN COUNTY, NE ,Pv YORK
. September 27 19 91
, Date
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This is to certify that work requested to be done as shown by Permit No. 91-657
has been completed.
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• ' This structure may be occupied as a single family mobile home
• • Lot 94 Gregwood Circle
Location
Property Owner
Owner Prnk Prilloi Pnrpqt Pnrlt Mnhilp 1-lomp Cnurt
By Order Town Board
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TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
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CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY`
WARREN COUNTY, NEW YORE
Date November 4, 19. 91
This is to certify that work requested to be done as shown by Permit No.
91=657
has been completed.
This structure may be occupied as a. Mobile Hole
Location Lot #94. Briwood Circle/Forest Park Mobile Home COurt
Owner Roy & Edna.Belmore, Jr
By Order Town Board
TOWN OF QUEENSBURY
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C\\*Yk-
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Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-657
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Forest Park Mobile Home Court
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OWNER of property located at Lot #94 Gregwood Circle Street, Road or Ave. i—i
W
in the Town of Queensbury,To Construct or place a Mobile Home C
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 0
215 Ballard Rd �.
Gansevoort, NY o
2. CONTRACTOR or BUILDER'S Name a
Today's Modern C
0
3. CONTRACTOR or BUILDER'S Address
Rte 9
Gansevoort, NY 12831 0
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address 0
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6. TYPE of Construction-(Please indicate by X) .nr
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( )Wood Frame ( ) Masonry ( ) Steel ( )
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7. PLANS and Specifications
CD
No. 14' x 66' Mobile Home as per plot plan specifications and application c
8. Proposed Use
Mobile Home
$ 29'00 PERMIT FEE PAID -THIS PERMIT EXPIRES September 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 this 17th Day o Septembet 19 91
SIGNED BY tom -� for the Town of Queensbury
Building and Zoning Inspe, or
TO BE COMPLETED BY fLL'C. DEPT.
Application No.utui1 of Que ',ai1u,,
BUILDING and ZONING DEPARTMEar
NT Permit Issued 19
Permit •Expires 19 /—6:7S?
Bay and Haviland Road, R.D. 1 Box 88 Zoning Designation
Oueensbury, New York 12801 Variance No.•
Site Plan Review No.
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APPLICATION FOR Ut^-c
y:
• MOBILE HOME 1._ /.
-FUILDING AND ZONING. PERMI=T . 4,A6
* * * * * * * * * * * * * * * * * * .* * * * * * * * * .* * * * * * * * * * *::*
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 i:: accordance with the description, plans and s
special conditions as may be indicated on the Permit. specifications submitted, and such
21:1(-tbk-C-.a..C121-2-2217.10-( -
The owner of this propertyl is: FQRE.Sy /6.) iqk (i4o, C6 /Io'�E :coi
P.U. Address re 12 i-.�/.> ,d 4.7D
/ ailsevDDJl l.s
/ 7-/ yy7
Property Location:
/,e(?-/'F— Le.)/ 9/ Tax Map. No. l_f
Oo L >Street ::umber or building lot numbernu
Subdivision name (if applicable) ,/Cb,feS 7 F� /�
rr /9•C` E�r1o/LFTILE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:(4.?
15"5 I314411E72
Name P.O. Address `
/ Tel. No. •
Name of Installer/CDT-Ai /�Ji� dresa Y ����� ��9��«da�2y 7 756_lam
Name of plumber Tel. /
Name of masonlum Address WV /?ti1/ Tel.
Address _ Tel.
MOBILE HOME INFORMATION: * ZONING INFORMATION:
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New Home Placement y * A PLOT PLAN MUST BE PREPARED AND SUBMITTED, .
Replacing existing Home ... drawn reasonably to scale and attached hereto,
r showing clearly and distinctly all buildings,
Size of 'new Home l f ft X &4 ft . * whether existing or proposed and indicate- all
• *
Single w ?e Double wide set-back dimensions from property lines. .Give
street and number or lot number and indicate
No. of rooms (excluding baths) * whether interior or corner lot. Show location
No. of bedrooms * of water supply and location and configuration
* of septic disposal area.
No. of bathrooms
* COMPLETE INFORMATION REQUIRED BELOW.
Fireplace?/1/'2 Wood stove? Al ) * Size of property ft X ft.
Foundation style and size: * Existing building(s) Size ft X ft.
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Piers- No.of / ' e- ft x ft.
Existing building(s) Use
Depth ow rade ft.
FOUNDATION _ Footingnsize X „ . Proposed building, disLance from property line
Wall material /f�H- * Front yard ft Rear yard ft
t/ 111 * Side yards ft and ft
* If on corner, setback from side street ft
Wall thickness " Height ft. •
Total depth below grade ft. * OCCUPANCY INFORMATION
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Grade to Home floor level ft. * PRIMARY BUILDING -
* One family dwelling
O� * Two family dwelling
Proposed date of placement / / /9/ _9( ,* Multiple dwelling / NuMber of units
Aprox. Value. of Home $ ay Sd 0 * Permanent occupancy
* Transient occupancy
Water supply - Well Municipal K. * Business •/� * Industrial
Septic Permit required? /iJ Other
*
* If addition, what will use be?
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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
*
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Form MIIP 5/86 and-vl
APPLICATION FOR MOBILE HOME PERMIT, (CONTINUED)
State of New York Division of Housing and Community Renewal
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INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
1 . INSIGNIA SERIAL NUMBER
2 . NAME OF MANUFACTURER k,s• c /l/
3 . PLAN APPROVAL NUMBER 01/4S 53 •
4 . MODEL OR COMPONENT DESIGNATION -7° 'VV. i )J 7 6 fo
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5 . MANUFACTURER 'S SERIAL NUMBER c /U — O 64C-13)
6 . DATE OF MANUFACTURE i2,7P,o2n/
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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.
AA * A A * * 4 A * # A A +F * A * * *' .* 4 '4 • A 4 4 -* * d * # d A 4 4* # 4 A
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Town of Qucensbury � *
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 proposed work shall be 'complied .with, whether: a •acified or not, and that such work is
authorized by the owner. ' .
Signature I __ 44/ J!_1:41 •
Owne , owner's agent, ect,cactor
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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.N DATE
-.2 /.
CITY OR VILLAGE ") TOWNSHIP AI' COUNTY
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/!�./ �4- ��lam` t/-- (.
POLE NUMBER
STREET AND NO.OR ROAD / `"1 4,7
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BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT
ODCUPANT'S NAME BUILDING OCCUPANCY
Y-C ---7"?�:'"?'(-
OWNER'S NAME AND ADDRESS ,. • HOME TELEAIONE NUMBER
CURRENT SUPPLIED FROM THEIR OFFICE WORK TELEPHONE NUMBER
4/BY/ ,/;VJ
BUILDING IS
NEW L< OLD❑ WORK IS NEW❑ ADDITIONALsr1(..s. 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.
e.,;?rti,i) C j.7"" }ni 0 r /"7 6-ic l G=! /7 .),--vc"
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 OF WORK LI EXPOSED GAS TUBE SIGN/TRANSFORMERS OF VA
❑ CONCEALED
DATE WORK TO BE STARTED DATE COMPLETED SIZE OF SIGN(NUMBER) CAPACITY
/'
SERVICE ENTEfIS BUILDING �// MANUFACTURER OF SIGN
❑ �-�
OVERHEAD L:.3/NUNDERGROUND
DATE INSPECTION REQUESTED ON(OR AS NEAR AS POSSIBLE) MUST ENTER APPLICANTS I► I ,, . I
IDENTIFICATION NUMBER 7 -'-. Li /1 L,i I
AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
PRINT NAME AND ADDRESS I /
NAME OF APPLICANT / DATE QF APPLICATION SIGN URE cIF APPWCANT i%
/6v^-9 .l ✓ 4'IJ1.)C•2---11 r -,}!r7C, `%f �! X 3/0•J-- 4 ;f
STREET ADDRESS TELEPHONE NO:
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CITY R POSTTt OFFICE s, / 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
(212)227-3700 (518)463-2122 (716)884-1155 (716)254-0141 (315)463-8552
THE NFW YORK BOARD OF FIRE UNDERWRITERS
• f-149-11-\.9_-1-neL3"l1.&" 1"-•)t(...tt{..17!.- ,!,-", C-r1.!..1.!.,1"!. i.a i,t(.?L,?°.C;ti,a.!-"."--.?(..?.,.-4- C"-.a.9 )._C?tl.?ti.?te. .1.,a-.!,-. .(.1.?1ti" 1.9i. n ,"•1.! !1:4t+1t,, Vy:e.
�. THE NEW YORK BOARD. OF FIRE UNDERWRITERS PAGE 1 o
ii.` 206784 BUREAU OF ELECTRICITY
r • 41 STATE STREET,ALBANY.NEW YORK 12207
Date OCTOBER 0 ,,1991 APPlicati , ; o.on J 7939691/91 • A 059449 0
� THIS CERTIFIES THAT PERMIT NO. 91-657
only the electrical equipment as described below and introduc on the above application number in the premises of
so
it ,BELMORE/FOREST PARK, FOREST PARK, OUEENSBURI, N.Y. .
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„I' in the following location; ❑ Basement ❑ 1st Fl. ❑ 2nd Fl. OUT Section Block Lot 94
1� �^ am �� J 9 �� '
!`, was examined on S E•I :EMBER ' 7;19 91 and found to be in compliance with the requirements of this Board.
FIXTURE I FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
'• ECEPTACLES SWITCHES
OUTLETS INCANDESCENT.FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. l H.P.
�' DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS: MULTI-OUTLET DIMMERS
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SYSTEMS
1: 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
CD ij
l'4; SERVICE DISCONNECT NO.OF S - E R V I C E '
AMT. AMP. TYPE EMQEUEP 1,B'2W IA.3W 3,B'3W 30 AW NO.OARCOND. OF CC.COND.. NO.OF HI-LEG OF HI-L G NO.OF NEUTRALS OA.W.G.
RAL
J,
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j OTHER APPARATUS:
F. r:
1. PANELBOARDS:1—2 CIR. 100 o Y
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<y; •
-V TUD AY MODERN DOMES .
-<' S-I ROUTE 9 _ Uu?
�• BRANCH MANAGER
G?NSEVOORT, NY, 12831
239 ii
- Per :
c,; 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•,.-_,e-ciii;. ® ® ® ® o ® oIn ® aa ® ® aa ® a •.... ;,;:.; ;.).
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. r
�,v4vy - a I Pill
TOWN OF QUEENSBURY
/A► 531 BAY ROAD
;Jr' NEW b QUEENSBURY,TELEPHONE (518)0745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED rf 7/9 P
NAME�O�C�, ZLIr k 10 b, 1 e / 7iQvkLOCA
TION 914Go(3CtvcJQDATE 91 7 /' PPEnRMIT# qt
TYPE-OTRUCTURE
V \f l e- �co�
RE '
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING _FINAL ELECTRICAL--_SEPTIC
INSULATION WOODSTOVE/FIREPLACE
REMARKS
APPROVAL
N/A; YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION
PLUMBING VENT ' ,/
ROOFING I ,/
SIDING (/
DECK/PORCH/STEPS/RAILINGS ,1 J
RELIEF VALVESFURNACE/HOT WATER OPERATING
BASEMENT INSULATION/DUCTWOR;K
INTERIOR TRIM/PRIVACY DOORS',FINISH FLOORS: dy
BATH/KITCHEN WATERTIGHT 1
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
HANDICAPPED ACCESS /
SMOKE DETECTORS / 7,
BATHROOM FANS/WHOLEHOUSE FANS
ALL PLUMBING FIXTUAES OPERATING
GARAGE FIRE PROOFING ;_
DOOR CLOSERS / \.
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS
DUMPS TER -
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C r
COMMENTSi:' !��
ALL Pf.CrL l�o�% c/ IJJ� ' /
10g, ��� c�J �,v .1)v( )
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ARRIVE
fDEPART 7-
INSPE' TOR
WESTRIDGE . .
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* -_ I"" l= UTILITYjl DINING
6409 66x14 fl.,rflr i AREA. J BEDROOM` i BEDROOM
0 p. MASTER � No 2 No 3.
3=BEDROOM CENTER. • I BEDROOM / " G 9 a , io s'
KITCHEN•2:BATHS• -. ` B ,No'4„ KITCHEN LIVIN4 Boots
GARDEN TUB. . o„ ® u.� U
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GOin r: Pacy, /ot 91/