1993-103 riY r
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CERTIFICATE OF- OCCUPANCY '
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Daie 7 2/ 19 93
This is to certify that work requested to be done as shown by Permit No. 93-103
has been completed. doubl ewi de single family mobile home
This structure may be occupied as a
Location Corner Rhode Island and South Avenues
Owner Robert and Connie Ackley
128®8®1F 2
By Order Town Board
TOWN OF QUEENSBURY
•
Director of Bldg. & Code Enforceinent
' - x
BUILDING PERMIT
TOWN OF QUEENSBURY •
No. 93-103
WARREN COUNTY, NEW YORK
to
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PERMISSION is hereby granted to ROBERT AND CONNIE ACKLEY
OWNER of property located at Corner Rhode Island & South Avenues Street, Road or Ave.
Doublewide Mobile Home
in the Town of Queensbury,To Construct or place a
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.
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1. OWNER'S Address is r'
RD#4 Rhode Island Av -<
Queensbury NY 12804
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2. CONTRACTOR or BUILDER'S Name rD
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Adirondack Housing
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECTS Name
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5. ARCHITECT'S Address 0
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6. TYPE of Construction—(Please indicate by X) CD
( )Wood Frame ( ) Masonry ( )Steel ( ) ti
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7. PLANS and Specifications
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No. 24'x481 Doublewide Mobile Home as per plot plan, specifications o
and application. _
8. Proposed Use
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Single family dwelling/doublewide mobile home
47.00 April 16 94
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the cr
town of Queensbury before the expiration date.) .�
to
Dated at the Town of Queensbury this 16th Day of April 19 93 n
SIGNED BY 'c 0
�QG ��,�,��,��� � a zlu for the Town of Queensbury cr
and Zoning Inspector =;
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•
TOWN OF QUEENSBURY
REVIEWED BY:
FEE PAID: $ 9/;7
PERMIT NO. 93101
APPLICATION FOR PERMIT
MOBILE HOME OR MODULAR
A BUILDING PERMIT MUST BE OBTAINED BEFORE PLACEMENT OF MOBILE HOME.
NO INSPECTIONS WILL BE MADE UNTIL A VALID BUILDING PERMIT HAS BEEN ISSUED.
The owner of thi s property i s: kC) e-a Cot'vlV j e 61al
P.O. Address: Rpq pyone m'UD-4de. ews ;; y uipy Phone Number '75d''' .3.1,,
Property Location a.or o ,`�L '2 0a14 c -c 50A aU2.Tax Map IQJo. /
NAME OF APPLICANT: f G�erV/ Coy- e Acde
Address of Applicant: (Kfltj {N TdahfDq,,,e, QueerciaxS AA/. (xby
All applicants spaces on this application MUST be completed and the
signature of the applicant MUST appear on the reverse side of this application.
PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES:
MOBILE HOME INFORMATION APPROXIMATE VALUE OF HOME: $ 7 C10 0,00
New Home Yes No ZONING INFORMATION: O A. /00
"9 o x f Ua
Replacement Home ` No Size of Property: = ti^ ft x ft
Size of mobile home r2 ft '-r) ft Existing Buildings: yeG VFouse Qy-A
Singlewide • Doublewide I C oc- 9 Qea-
Proposed building-distance from property line:
No. of rooms (exclude baths) Front Yard 43 ft Rear Yard 5'7 ft.
No. bedrooms 3Side Yards 3o ft ands ft.
Occupancy Information:
No. of bathrooms 2 Primary dwelling: Yes No
Fireplace '--'" Woodstove Accessory Building(s):
Detached garage (one car p two car car)
Foundation style and size: Attached garage (one car /two car car)
Storage building
Piers-No. of Size ft x ft —Other
Depth below grade . ft * * * * * * * * * * * * * * * * *
Foundation-Footing \size ay " x yg" Proposeddate of placement:
Wall material S\a'b Cone S'eA e na 1G +ken St'"� (jc
Wall thickness " Height Water Supply: Well Municipal
Total depth below gradervih fet. Septic permit required? /Vo'
Grade to home floor. level ft.
FURTHER INFORMATION REQUESTED ON THE REVERSE SIDE OF THIS SHEET
NAME OF INSTALLER/MOBILE HOME DEALER: PlaironolaCk11005)5
ADDRESS PHONE NUMBER ,nO —/g 79T"
/ i 1� �0.,c'0.�c�Ct, Q v 2 h v•�.SG��e nS ����S �ll� � 3 C
STATE OF NEW YORK DIVISION OF HOUSING AND COMMUNITY RENEWAL
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
1. Insignia serial number
2. Name of Manufacturer ��I:\`n'1D(O
3. Plan Approval Number
4. Model or Component Designation
5. Date of Manufacture / J 93
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.
•
Town of Queensbury State of New York
County of Warren
AFFIDAVIT
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 t e o ner.
Signature
Owner, owner's agent, architec
contractor
SPECIAL CONDITIONS OF PERMIT:
By
Code Enforcement Officer
,,..
FORM 4, /..APPLICATION (REV 1/136).
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THE NEW YORK BOARD:OF-FIRE UNDERWRITERS 41 STATE STREET 7 %.: ..".,.i. :.:,. CERTIFICATE NO:---,:,
ALBANY,N.Y. 12207. , ''' '•• It' '' . •
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•• . , ., YOU ARE.HERESY REQUESYED,TO :n',..,,, : .,, , , ,
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'INSPECTANDISSUECERTIFICATES ......, .-
FORTHEFOLLOWING ELECTRICAL ' :,. . .
EQUIPMENT TO BE INSTALLED BY 1...,ILDING PERMI.T NO.
THE UNDERSIGNED. ''''
-
'TEMP.* DATE 9.1- /O3
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CITY OR .; • . .... - ' • - - .
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VILLAGE at....0&4"X/54 0,47 y' . •• ,_
:TOINNSHIP
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STREET AND NO.OR ••.' ;•0 !- • p - '7--'4 f••?•1'1. . . ;L
ROADANDPOLENOf4) 4. /2 # AZ "'X e 'Pol NO.
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.. • BETINEEN WHAT TVVO. '," - •'••'•••!•'•4.''':'..,-,'IY.:7.1: 1:••••0.. •• •: - ':•;•,•••-•'- t' .!;: .• .. . ••.• -• : • ' •..' ' '''1,•;! . .
CROSS STREETS IS . "i"?':• ' . 4-'•u11I,F,''',",.-..r,:•.: '4. : . . . ..
•.', PREMISES LOCATED?, " '.• ' .:: ..•1':.—',L_-. 1 - • . SECTION- • , • • .BLOCK•... . LOT . ... -
OCCUPANTS 1‘• -A......... a ,a.c.,,.... apa'' _2_, ,
co(..y.ic 4,.c._C„,e7‘.4.,,,), -occupANcy 1,...•0 :4,,,i,c• A 4,/„X/a.,,,;-•-- • - • -.- : .' -
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OVVNERINANIE'-:•ii,;:-14:;:'At.:t•„,,,,,,• :4',.,. , '4.:'“''''?'.•' • .. .
AND ADDHESS,',7-`,-..3.,or...:ir'Zia, ''•-' '.'', • ' ' '' . . .
• • .,. • TEL #' .;..',"':L •-•" --'-'''';'-, :"'''' • ' .:'..- "'.'
CLIHGENT • , i s - - .. '
SUPPLIED ^ 1 2;;;..;';`•11. ,.•, i::,-,,,..••••• ... 'L., .•?BY • Akt/...f.t.1/-•••-;,•••••".,•,,, ' .:,• •;.•,,,,;',',:i',,, .. . ,.. ,,'1, '.'.. •., F4?R,O,M.,,t...i. k.IB• .'s z,•'..z.c4... •,.-,• ':'.-'....1.,?•/,--,,7b.::7•:;--:. Ai,.i 34 orrtr.1F ic.,-e..`j-.;,,,,,,c;;•4';.,P,?..;',:.
BUILDING -1--•- - -."-r±r-..="31-7: ..... 2,- ' WORK .,•allr: ':, -.:,• ' %t.,,"3,,:.. DEFECTS ,--,
IS : ' NEW! ' :'•••t- '.!i'olb'll' . . ' . . ‘..00/1.1,' : ADDITIONAL LJ, , .pgmovEi3 LJ
. L' . • --:'''' .." ": • LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
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. . . ,_ . . . ... .. . ... . ...
. . .";,'",V:di.:,' NO.Of FlitiliWijst-.''':.'.' '• ....- . • .
. .• • , BRANCH,'. 1:::' :: : ..; •
NUMBER OF OUTLETS:1,:--• 0,1 Lirrip Racal/tides' ' 1 • MOTORS'... HEATERS '.• CIRCUITS •i.-.4;•L . OFFICE USE ',-• ..„. i
Lou- . ,. • , .i'7.‘.3.1;,!', 'r. , .• •' • '1 • . ONLY
Von
--1,;,1,-•;1---,'-••;- •-• ; • : • H.P. • Waite i, A.W.G. -I ,. •
'.-,.. ., . .iNSPECTION:. .••-,.• Ceiling mil Recol, .uviitth••plintlini Bracket N'o.'.. Type Esc!, .Nci. E„1,,- No., gar* :
•*. ! '. '7., .-' ; ..::-.•-:'''' 1-''''' -; •...
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Out- '' :
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side ,
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Silb-• . .•,
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base ' .
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Base- - - • -- -
ment ..
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let Fl. '-''' •
2nd Fl. ' . . , '
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3rd 01. . . .' ' , .
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REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: . .
.."-, , DO ISIOT USE THIS SPACE. !
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. . . .
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to a /1-)4fA _A;Per.-&-..- c.5 ,,/,PiC 49 .•,. ,.-.i.,.;-. :-•._ ,
This application la intended to over the abOvailiatad equipment to be inspected Mit if at time of Mineefion there ii found additional equipment not above listed.
you are authorized tir Make the inspection and idiLiii the fee to cover the addiiional equipment;as piovided by the applicant. . .•,.. _ ,
SIZE OF •• •,•.• --'.‘' . , ,,. •..". 1 • , .•..1'.. •",•.,•1,•' ELECTRIC SIGN, - : •'. ....: TOTAL
MAINS '• ; FEEDERS LAMPS::' ,,. , . ''' • •"'•WATTS
... . .
CHARACTER ' EXPOSED GAS TUBE SIGN '
OF WORK . , . • CONCEALED TRANSFORMERS OF• VA '
WORK TO BE , ' I . (NUMBER) (CAPACITY)
1 STARTED .
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.
. ! COMPLETE0 SIZE OF SIGN
. . ,
' .
SERVICE'•,, OVERHEAD • UNDERGROUND • MAKE01 .
' '
' ENTERS.. .
BUILDING - OF SIGN . .. , ..
INSPECTION REQUESTED• , .. . • - , .
ON OR AS NEAR AS . :-.- 6,c)/44,,, : .5 1... z•-- NEW 11 . ,. OLD 0
POSSIBLE
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACES , i• •....7. s'' DATE OF ' 4 i ';In ila Aa.i 1 .
MUST BE FILLED IN OR APPLICATION MAY BE HETURNED. . : • ' ; '121'1.A i: ''1.."'.- APPLICATION.ot,,'..--xi 7-x-,-r• ',-- •.-.."`- . : . -
PRINT NAME AND ADDRESS ' ' CI
• X SIGNATURE .. .
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NAME OF... te,41,,A6e.if h0.:. 4.4 Z.0 1.1/4"Pi C.
APPLICANT •s- . ! ‘' ' • -60'Aii0LicAin..-41-4:21t 'r. 74 - . '
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it.A ... ,, , "ft. • .
# VeAt."".2.40 ,5-' •
STREET ADDRESS (21. V P>40 4, 07•l'...-"*".!"..4.: '177.J • L., •'• . • - TELEPHONE •• ''''•-- - •. • . - ' • •
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POitSYT600010E714.e hth)Y,• ,pii44,..4. . , .• • CODE lolt/r. 1-4.EN A,ipLec.A.Li ge I f 0-.5--a.7 '
. .
46 EL (REV. 1/86) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
.
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tc. THE NEW YORK BOARD OF FIRE UNDERWRITERS E=I-': i:, 1
• 11000567
' BUREAU OF ELECTRICITY
r 41 STATE STREET.ALBANY,NEW YORK 12207
MITI 2 i,99.3 11Q 34693/a A ?£i=i, 3
•4' Date Application No.on file :,
THIS CERTIFIES THAT gJ -I a3 :
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
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ILsfi r '.i' & COW�ll.ii tiC".Ibl_T!nz' BHOfl1; ISLAND AVE. FiJ- , �IriF;IeA):ii3U! ii, `.
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.,• in the following location; ❑ Basement ❑ 1st Fl. ❑ 2nd Fl. Section Block Lot �
-c MINE 1q, 19'-
�l was examined on and found to be in compliance with the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS :'
�, OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. •'_
IA.': 'i
< DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS •-'1"
s' AMT. K.W. OIL H.P. - GAS H.P. _ AMT. . NO. A.W.G. AMT. AMP. AMT.- ._AMPS..TRANS. AMT. H.P. ' NO. ET _AMT. WATTS ':
SERVICE DISCONNECT NO.OF - -. S -
METER
!• AMT. AMP. TYPE EQUIP. 1 A 2W I A'3W 3 A'3W 3 A'AW NO.OF C CCOND. OF C .COND.. NO.OF HI-LEG OF HI•LE^ G NO.OF NEUTRALS OF NEUTRAL •,1
1.
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-rt; i. 100 CO1 X t l a
_
-,' OTHER APPARATUS:
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9
CRftNSTON ELECTRIC C ''
i. :-I II l;,T!?VT.LLI�, ROM) 01,07e::
�; U{}X 24 BRANCH MANAGER '.•
�' txi'aCHAN CVTLl._[ NY, IMP, ,4 'i
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Per
• 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.
• ® 000 ® ® ems ! ® a ______ ClffiEMEIEMNENFIVIIIMENIE 5521 ® .
COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
TOWN OF QUEENSBURY /
���'
!�► 531 BAY ROAD
-`. V- QUEENSBURY, NEW YORK 12804
. TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RREECEIVED
NAME 6-4-elf t ! rX/yL-Ce. ,t-
LOCATION 67 Ao e % lew& 64 J
DATE i/ /( 43 PERMIT# q3—/0.3
TYPE OF STRUCTURE u19/e/,l46@.L 1 14/-
RECHECK •
_FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
_FOOTING FOUNDATION BACKFILL FRAMING
_ROUGH PLUMBING FINAL ELECTRICAL SEPTIC
_INSULATION _WOODSTOVE/FIREPLACE _
REMARKS
APPROVAL
CHIMNEY HEIGHT/LOCATION N/A YES NO
B VENT/LOCATION
PLUMBING VENT
ROOFING /
SIDING
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES r
FURNACE/HOT WATER 0 ERATING !
BASEMENT INSULATION DUCTWORK„`
INTERIOR TRIM/PRIVA Y DOORS,/
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT !
OTHER FLOORS SWEEPABLE y
OTHER FLOORS CARPETED i
STAIR CLEARANCE/RAILINGS'
HANDICAPPED ACCESS ,lpV
SMOKE DETECTORS A X.
BATHROOM FANS/WHOLEHOUSE‘FANS
ALL PLUMBING FIXTURES OPERATING
GARAGE FIRE PROOFING'
DOOR CLOSERS .1 \
OTHER FIRE SEPARATION `!,
FIRE/DEMISE WALLS/ k
DUMPSTER 00
SITE PLAN/VARIANCE REQUIREMENTS°
FINAL ELECTRICAL" (3.1.)S -F- - \ Nc
OK TO ISSUE C/O OR C/C e X
\
COMMENTS: l i \
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ARRIVE /;�"`
DEPART
IN P
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT //22
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR°S REPORT
REQUEST FOR INSPECTION RECEIVED J5XV Ql/bpi
NAME
LOCATION &4 Rhode(,de , -A474/ ( di,11
DATE 4FM PERMIT # 91.a-1O3
TYPE OF STRUCTURE ,9 /1 z,e_aL) /v!ld
RECHECK APPROVED
N/A YES NO
XFOOTINGS/PIERS
MONOLITHIC POUR ORM �N •REINFORCEMENT IN PLACE •
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM '
FREEZING FOR 48 HOURS FOLLOWING ;/
THE PLACEMENT OF THE CONCRETE. al,;'
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE °%
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL 1 tj
ROUGH PLUMBING .,Y ?
PLUMBING VENT/VENTS IN PLACE X
PLUMBING UNDER SLAB t
FRAMING:
JACK STUDS/HEADERS ,r
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM ;l
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:
e /I
ARRIVE /-oc j
DEPART
• INSPECTOR
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