1993-089 <.6
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CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date ,,?#‘419
This is to certify that work requested to be done as shown by Permit No. 93-089
has been completed.
This structure may be occupied as a singlewide mobile home
Lot 61 Northwinds Mobile Home Parks, Luzerne Road
Location
owner Daniel and George Drel.los
Mobile Home Owner: Jo Lea Vaughn
By Order Town Board
TOWN OF QUEENSBURY
V
Director of Bldg. 6c Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY
No. 93-089
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to JO LEA VAUGHN
OWNER of property located at Lot 61 Northwinds, Luzerne Rd Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Singlewide 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
George & Daniel Drellos 0
PO Box 224 m
(lens Falls NY 12801
2. CONTRACTOR or BUILDER'S Name
Lamplighter Homes
3. CONTRACTOR or BUILDER'S Address
RD#2 Saratoga Rd
. Fort Fdward NY 12828
rn
4. ARCHITECT'S Name �.
0
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. 14'x74' Singlewide Mobile Home as per plot plan, specifications
and application.
8. Proposed Use
CD
Single family, singlewide mobile home. �•
$ 35.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 8 19 94 cr
(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.)
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Dated at the Town of Queensbury this 8thuay of April 19 93
SIGNED BY r for the Town of Queensbury
Building and Zoning Inspe r
F erai W 'TO , . UEENSB
URY •
APB Y 1993
REVIEWED BY: aepe
CODE DEPT.
FEE PAID: $ ��-
PERMIT NO. 9Qef
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 this property i s: ' a 111W I N o ) E- 07( �121/
P.O Address: ,� j2.Z ��� ' Phone Number %902-52j3
Property Location 5# riir
Tax Map No. 93/ .P-/ �
NAME OF APPLICANT: L4rn& ) ,i j- /4o(y)cs floc
Address of Applicant: I AR f.,i\
ZC,9 V 9G cir4/ •
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
GI!)
APPROXIMATE VALUE OF HOME: $ 20New Home No
ZONING INFORMATION:
Replacement Home Yes 1d
10
Size of Property: ��- ft x /r® ft
Size of mobile home /I/ftx 74/ft
Existing Buildings: /U[ L
Singlewide y, Doublewide
Proposed building-distance from property line:
No. of rooms (exclude baths)
Front Yard ® ft Rear Yard go ft.
No. bedrooms Side Yards and
Occupancy Informat' .
lil
No. of bathrooms
Primary dwelling: No
Fireplace_Woodstove
Accessory Building(s) :
/lenv \ Detached garage (one car /two car
bt &za(X \ Attached garage (one car car)
Foundation style and size:
Piers- ��, Storage building --/two car car)
of Size ft x ft
\ Other
Dept, below grade ft
* * * * * * * * * * * * * * * * *
Foundation-Foting s ' e " x
Wall material Proposed date of pla emen •:
W 0 po/
Wall thickn-:s Height " Water Supply: Well Municipal (
Total d-dth below grad- ft. Septic permit required? NJ
f7
Grad - to home floor level ft.
FURTHER INFORMATION REQUESTED ON THE .REVERSE SIDE OF THIS SHEET
NAME OF INSTALLER/MOBILE HOME DEALER: X4171 PLI(-y-'TEe //OY77:S I/U O.
ADDRESS/PHONE NUMBER 2 %- rtuPRa , rc.3-
STATE OF NEW YORK DIVISION OF HOUSING AND COMMUNITY RENEWAL
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
1. Insignia serial number /40YYJl guici —
2. Name of Manufacturer (LJLD fU>i /gyp (fl <)
3. Plan Approval Number
4. Model or Component Designation ./D 1-
5. Date of Manufacture ✓v B� RJ62ED
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 the owner.
Signature - i4e
Owner, owner' s agent-," a chitect,
contractU
•
SPECIAL CONDITIONS OF PERMIT: •
•
By
Code Enforcement Officer
'��� '" MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
i�a
National Headquarters
900 Haddon Ave., Collingswood, N.J. 08108 •
APPLICANT COMPLETES THIS SECTION Date: y rT/9 5
City, Town or Township 1C(/V�'t,�7O county 44.' 1 F �2 State �`
Location/Address AU% ��1 Iti6 i11W)i + .`� MC)6Ji. PO eewe, ,�.(1 ci Jo i j
(If Located in Dural Area - Please Attach Directions)
E' V c l vv a-12 41N�"EIfl,4'dV 4 r'l� iteCACAA Perm# r`. `_'
OwnerI (� 1 Permit # t°y "�t( a
Occupied As Qs 614,C' , g`-,17::Koete-- f Building: Newt Old
Occupant `-oc-iric
Work Area in Building (Floor #,etc.):
App. for: Wiring❑ Service n or: , Ok'—Oa ,#J {'rC'�"?OAJ Ready for Inspection:
Fee Remitted-$ Cash n Check n M.O. n Make 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 f®C,)
Lighting Amp. Service Surface Unit Dishwasher- Range
Receptacles Water Heater Air Conditioner Dryer Pump
Number of Fixtures Oven Garbage Disposal Wiring and Controls for Burner
Amp. Receptacles Fractional H.P. Vent Fans
Other Equipment:
MOTORS H.P. 1/201/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1'/z 2 3 5 7,/2 10 15 20 25 30 40 1 50 75 100
Mark Number '
of Each Size
Applicant's
Signature License # Permit #
T/A Utility:
Applicant Address: i-')e '31;L ; 111,2 �f"'12I � C (NAME) (OFFICE LOCATION)
(City) 1-I: € a,:J> f State)_ �)/ (Zip) le?aag- Service Request #
Phone # Electrician: lif
MDIA USE ONLY DATE RECEIVED: DATE INSPECTED:
Correct Location: Same as Above n or:
Red Notice Label n
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 1/8 1/6 1/4 1/3 1/2 3/4 1 11/z 2 3 5 71/2 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size I
500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Elect. Heat i
CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECTFEE FEE PAID
❑ RW Progress: Inc.❑ LKD❑ Contractor
❑ CFT Violation: Work Comp.❑ Inc. ❑
n L/A Owner CASH ❑
n L/A Fee CHK #
Due MO #
n IPA .- Municipal
INV #
Date:` ' Other Side❑ Utility " Applicant nOwner ❑
-
Cut in Card - n Temp # Date
-
n Final # Date INSPECTORS SIGNATURE
APPLICATION FORM NO.250 EL 4/89 - - - -
TOWN OF QUEENSBURY �' /
�
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED . 71l/j
NAME 9) a` T` Y
LOCATION ) f 'p/ -V 4v
DATE 4Vikl PERMIT# 93—DI9
TYPE OF STRUCTURE " �� �N 2j
RECHECK �
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING FINAL ELECTRICAL _SEPTIC
INSULATION WOODSTOVE/FIREPLACE
REMARKSp�� ���� s
APPROVAL
N/A YES,' NO
CHIMNEY HEIGHT/LOCATION /
B .VENT/LOCATION ,
PLUMBING VENT •
ROOFING
SIDING 1
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES _
_. _ FURNACE/HOT WATER OPERATING
BASEMENT INSULATION/DUCTWORK
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS: ;,'
BATH/KITCHEN WATERTIGHT, 7
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED V
STAIR CLEARANCE/RAILINGS/
HANDICAPPED ACCESS
SMOKE DETECTORS X
BATHROOM FANS/WHOLEHOUSE FANS
ALL PLUMBING FIXTURES OPERATING
GARAGE FIRE PROOFING
DOOR CLOSERS
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS'
DUMPSTER
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICALSL;Pp.vS.r6—
OK TO ISSUE C/O OR C/C
COMMENTS:
P(61" Li c_k ()LT cop_ ,c3 J
•
ARRIVE 9
DEPART
/L INSPEC R
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O iNmmInuniM 0• urn orr
11
o
/ w o� . \ BEDROOM 2 ,'•, BEDROOM 9
\ •POSTE r,�� DIHENNING
vAuT cacao nsu our 9'4' Pp��(
OR ® MASTER SUITE i UVINO BJ 1T<' A
13 B' I ROOM
u ir:tug 4'�—an.ox 1S Cr
i vT�"ilia inn= annmMnnu
KE104 3CK 2FB 2BA RB"UTL Approx.1039 Sq. Ft
7
it OF QUEENSbL...
RECEIVED
APR .:' 1993
'.r4. & CODE DEPT.
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