1991-718 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date •--rnalc-e-k,Th19
is is is to certify that work requested to be done as shown by Permit No. 91-718
has been completed.
This structure may be occupied as a Mobile Hem
Location Lot #95 Briar-mod
Owner Forest Park
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
a
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BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-718
WARREN COUNTY, NEW YORK ry
PERMISSION is hereby granted to Forest Park
0
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OWNER of property located at Lot #95 Briarwood Street,Road or Ave.
Vf
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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. R'
1. OWNER'S Address is
215 Ballard Road
Gansevoort, NY 12831
I—
O
2. CONTRACTOR or BUILDER'S Name c+
Today's Modern
tc
Route 9 Gansevoort, NY
3. CONTRACTOR or BUILDER'S Address
W
mat
4. ARCHITECT'S Name O
5. ARCHITECT'S Address
0
Q
6. TYPE of Construction—(Please indicate by X) CD
=
( )Wood Frame ( ) Masonry ( )Steel ( 1 — 0
fD
7. PLANS and Specifications
No. 14' x 66' Mobile Home as per plot plan specifications and
application
8. Proposed Use
Mobile HOme
$ 2q_OO PERMIT FEE PAID —THIS PERMIT EXPIRES October 11., 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 thi ^ / 9ay of October 19 92
SIGNED BY yGCUdvI /-�� for the Town of Queensbury
Building and Zonkbd Inspector
•
TO 13E COMPLETED BY BLDG. DEPT.
awn v Application No. ');47/� /
Quee,sj1u,,
BUILDING and ZONING DEPARTMENT Permit Issued 19
Permit Expires -19
Bay and Haviland Road, R.O. 1 Box 98 Zoning Designation
Oueensbury, New York 12801 Variance No..
Site Plan Review No. T WN OF QUEENSBURY
RECEIVED..
APPLICATION FOR Ap. -ved by .
' MOBILE .HOME .r�:(�/ OCT 7 1991
e+i.•
FU I LD I N, AND ZONING PERMIT .f� nG. & CODE DEPT.
�► � . ,►.
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: c tC6S 7- I -/Z/K /47. p��
P.O. Address , Z/ �j�G6,y` 4 e6,4� E4Ni&l/Ot' 4
/ i /Z�3/Tel. 6-8 V,/5�yy
Property Location: fsiZ/,4r76049kQ 9 2,C Tax Map No.
Street number or building lot number
/
Subdivision name (if applicable) 7/2 EJ T e ,ec
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
Name P.O. Address
__— Tel. No.
Name of Installer /p0.�f'jUc�4,/Address S7
Name of plumber 4tl7E 9��^/.fGr7��/7 �7�Tel. 78^/032
Address '7,/.4J, /„Z g/ Tel.
Name of mason Address
_ Tel.
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MOBILE HOME INFORMATION: * ZONING INFORMATION:
New (tome Placement *:. . * A PLOT PLAN MUST BE PREPARED' AND SUBMITTED,
* drawn reasonably to scale and attached hereto,
Replacing existing Home /1f 0
showing clearly and distinctly all buildings,
Size of new Home i‘i ft X 66 ft . ** -whether existing or proposed and indicate all
set-back dimensions from property lines. Give
Single wile • Double wide * street and number or lot number and indicate
No. of rooms (excluding baths) * whether interior or corner lot. Show location
No. of bedrooms Z • * of water supply and location and configuration
* of septic disposal area.
No. of bathrooms *
* COMPLETE INFORMATION REQUIRED BELOW. •
Fireplace? Wood stove? * Size. of property
459 ft .X ienjft.
Foundation style and ize: * Existing building(s) Size ft X ft.
* .
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Piers- No.of i e- ft x ft. * Existing building(s) Use .
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Depth be • ra ft.
* Proposed building, distance from property line
FOUNDATION - Footin s e " X II
* Front yard - ft Rear yard ft
Wall material * Side yards ft and
' ft
Wall thicknes " Height ft. r * If on corner, setback from side street ft •
Total depth below grade ft. * OCCUPANCY INFORMATION
*
Grade to Home floor level ft. r pIMARY BUILDING -
* One family dwelling
C * Two family dwelling
Proposed date of placement /C)/ fi / j/ * Multiple dwelling / Number of units
Aprox. Value. of Home $ Z 4/3 00 * Permanent occupancy
* Transient occupancy
Water supply - WellX' Municipal Business •
f * Industrial •
Septic Permit required? /v C/ * 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 and-vl
N�-= Q O-i FC, (4J c. CAE •� / _
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APPLICATION FOR MOBILE HOME PERMIT, (CONTINUED)
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Stateo:fNe'wl sY:ork.'.Division of Rousing and Community Renewal
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INSIGNIA OF APNIOVAL OF THE STATE BUILDING CODE
1 . INSIGNIA SERIAL NUMBER
2 . NAME OF MANUFACTURER YL•Pli' '.
3 . PLAN APPROVAL NUMBER
4 , MODEL OR COMPONENT DESIGNATION
5 . MANUFACTURER ' S SERIAL NUMBER •
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6 . DATE OF MANUFACTURE •
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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. •
4 * * * * * 4 4 * 4 * * 4 * * .* * 4 *.••* * * * 4 * * * * 4 * 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
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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.
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Signature 47(
Own-r, o er's age a arcnit t,cgntractor
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* • * * * * • * * * * * * * * * * • * * •* • * * • * • • * • * • • r * * • * * * * * * * * •*
' 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 l s ;
TEMP.H DATE !!!/ '
•
CITY OR VILLAGE TOWNSHIP COUNTY,-;,
STREET AND NO.OR ROAD �_ _-� �.� o-l�'y } POLE NUMBER
BETWEEN WHAT TWO CROSS STREETS IS PREMISES/'-LOCATED? SECTION BLOCK LOT
OCCUPANTS NAME tt -''j' BUILDING OCCUPANCY
,S LIU�{�. !
r HOME TELEP NE NUMBER
OWNEES NAME AND ADDRE,S/JS� p�f 1,rj' .,�j �G JZ� f ! ,HQ Ij/
Z:(r) , l !�fiG't ivi#-4. �-,/. % s/_S CVO IXE 7 1'1 l� % . / ...�' e% - /C' G,t
CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER
BUILDING IS Ai! /V/
NEW OLD❑ WORK IS NEW'❑`% ADDITIONAL❑ DEFECTS REMOVED❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS No.of Fixtures& MOTORS HEATERS BRANCH OFFICE USE
Inca- Lamp Receptacles CIRCUITS ONLY
ti0n 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.
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
/)0 %.'
CHARACTER OF WORK GAS TUBE SIGN/TRANSFORMERS OF VA
,,y�'!} /'' { !_ F ❑ EXPOSED
rb`/!JL;41` ,• :i/-7 - kW'7 C ❑ CONCEALED
DATE WORK fTOBE/STAR' f
TEED /L., DATE COMPLETED. SIZE OF SIGN(NUMBER) • CAPACITY
/C)7 C// 4/I - .
SERVICE ENTER BUILDING MANUFACTURER OF SIGN
❑ OVERHEAD *UNDERGROUND
DATE INSPECTION
REQUESTED ON(OR AS NEAR AS POSSIBLE) MUST ENTER APPLICANTS ► I � I ��f / 171 '+!
l.�'Jf C^ '9.L IDENTIFICATION NUMBER f 4 i -t
AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
PRINT NAME AND ADDRESS /1 �+
NAME OF APPLICANT / DATE OF -PPLI ATION SIGNrE OF APPLICANT �/
STREET ADDRESS �` - G� n,EELL� HONE Na i .,._
-/ �f J v �J ` �-s'.
CITY OR F)0ST OFFICE ZI
/ ,f P CODE LICENSE NO.WHEN APPLICABLE
C,Oi .-.11je—iiP. "7 /L t`l /e-v 4 t ..
❑ 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 (71.6)254-0141 (315)463-8552
THE NEW YORK BOARD OF FIRE UNDERWRITERS
m1R1Rlit70, an MV/10%.MR 01MI0Mt1R>Rw7R7JTJ 7R MAIM 7i11R710 10./01m71101i1711l11l71010‘7110l407wattat a lgl7♦ 7R1Rlitapcn i.tatanlaltalman
THE NEW YORK BOARD. •OF ..FIRE
UNDERWRITERS •PAGE 1
0 9,06784 BUREAU OF ELECTRICITY
0 F , 41 STATE STREET,ALBANY.NEW YORK 12207
0 Date OCTOBER 28,1991 Application No. nfil481037,1/91 A 060459
0 THIS CERTIFIES THAT PERMIT NO. 91-718 . .
Fi g only the electrical equipment as described below and introduced by the med on the above application number in the premises of
FOREST PARK M.H. PARK, 95 FOREST PARK, BRIARWOOD, OUEENSBURY, N.Y.
SE 0 in the following location; ❑ Basement ❑ 1st Fl. ❑ 2nd Fl. OUT Section Block Lot
was examined on OCTOBER 21 r 19 91 and found to be in compliance with the requirements of this Board.
FIXTURE ECEPTACLESI SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS '
OUETS TL INCANDESCENT:FLUORESCENT OTHER - AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
E .
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS DELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
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
SERVICE DISCONNECT NO.OF S E- _.__..__R _ , V I .. - C C . E.
AMT. AMP. TYPE EQU P 1 0 2W 1 8 3W 3 0 3W 3.0 AW NO.OFpERC1COND. OF CC.COND..J NO.OF HI-LEG OF HI LEG NO.OF NEUTRALS OpNE
' UTRAL
OTHER APPARATUS:
iii
! PANELBOARDS:1-2 CIR. 100
E .
II
E TODAYS MODERN HOMES '')-
0 54 ROUTE 9 � 2LL _?
0 G�v �7SEt OORm c q 8 - BRANCH MANAGER
AN A1V 41.'�1?l7l'1\1 r N3`r .L2031
Per
Ct 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.
RI 71i17v7tIII111.1]Nt lilt UVtf11411i1111(UVTf[t1111111 1vltttMitlatTr[v(Tf[v[it&1111 let 1111v11it let lilt]I11f11i1Aft'MI tfllillrl Ulf tf1]i1YI1 Wilinfiltnitt=CAWT![v7TRUV
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT-BE ALTERED IN ANY MANNER.
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME %'� G� ✓
LOCATION 5� /yf.C/.G'-�/,'
DATE 0/ /G� YPERMIT # G% 7/1
TYPE OF STRUCTURE /cA
RECHECK APPROVED
fN/A
YES NO
FOOTINGS/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
R - ---• n.,,- - - - --
F
B
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P I I
F l 6/ ?/
•
REMARKS: �-
r 2
ARRIVE
DEPART
INSPECTO
TOWN OF QUEENSBUR /1/92
Y
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
110 ?! TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED / ,
NAME o�� 74J'J i//Y U4fi. -
LOCATION Xf f J/A/5, 77_,/7/e. el./Le-4/6
DATE /c//t/h/ PERMIT# q/- J//
TYPE OF STRUCTURE `7z0--/..6 l, _-
RECHECK
_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
SIDING
DECK/PORCH/STEPS/RAIL` NGS
RELIEF VALVES
FURNACE/HOT WATER OPERATING
BASEMENT INSULATION/DU(TWORK1'
INTERIOR TRIM/PRIVACY D ORS''
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT;
OTHER FLOORS SWEEPAB,LE 1
OTHER FLOORS CARPETED , V
STAIR CLEARANCE/RAILINGS
HANDICAPPED ACCESS"
SMOKE DETECTORS :
BATHROOM FANS/WHOLEHOUSE FANS
ALL PLUMBING FIXTURES OPERATING �
GARAGE FIRE PROOFING_
DOOR CLOSERS r'
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS
DUMPSTER
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C
COMMENTS: •
. u _3W/erl
-0,511�
rj
ARRIVE ✓l
DEPART 4 ��`
INSPECT
TOWN OF QUEENSBUR'y
1ECEIVED
OCT 7 1991
BLDG. & CODE DEPT.
5130Z = --'--- ..
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on.
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2 BEDROOM•CENTER___________________
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BEDROOM L___I� .. JI o�... I I I I I II
2 BATHS•GARDEN TUB• , No. 1 ' I Ij'— —1— —1 #_-- li—_ '''' '—i '1!
0 BEDROOM .a:'I;
BENCH BAY•CATHEDI2AL "' 10 ' I' 1' I I -- --'r "o•z 9
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