2006-106 TOWN OF QUEENSBURY
742 Ba Road Queensbury,NY 12804 5902 (518) 761-8201
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Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number. P20060106 Date Issued: Monday, January 14, 2008
This is to certify that work requested to be done as shown by Permit Number P20060106
has been completed.
Location: 32 MINNESOTA Ave
Tax Map Number: 523400-308-016-0001-073-000-0000
Owner. RONALD MOREHOUSE
Applicant: RONALD MOREHOUSE
This structure may be occupied as a:
Mobile Home Out of Park By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the ,,
property owner of the responsibility for compliance with Site Plan, ftp'
Variance, or other issues and conditions as a result of approvals by the Director of Building& de En oncement
Planning Board or Zoning Board of Appeals.
., o(A.tt) OFFICE USE ONL '
TAX MAP NO. PERMIT NO. v 'U DATE ISSUED:
PERMIT FEE 1 , -0 APPROVALS: ZONING TOWN CLERK '
'
MOBILE HOME -APPLICATION FOR PERMIT: RE C P NE D
A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a
valid building permit has been issued. i.„ .1 1 0 ?006
Applicant Information Property Owner Information TOWty ,,itiUR`
`
BUILDING /AND CODE
Name: Al
b/1a(Q /140 ice.42C 1 Name: R0ic1d" mo�� f(c,fe
Address: ?oL /tel%tA,e.1'o-A 4-1-- . Address: ? Z /1/1/;/14 -eM ,1
Q t4i ' r /1. `t" (-/-20v c-t-e2.4,I',4c, /,—(- /2-d7c /
Phone No. SI) -7213 Phone No. Cr 7— 7,r3
Parcel Information /
Proposed Date of Placement: C/ /^0 6 Property Location: 3 2- e4,'in-es/4g -P
Road,Street,Avenue
Name of Mobile Home Park: (if applicable) Tax Map Number: 33 08, (6--/-73
Mobile Home Information Zoning Information
Approximate Value of Home: $ (2-A ' w Zoning Classification:
New Home: YesSize of Property: 11_1 ft. by too ft.
/6
g 0 !� e
Replacement Home: es No Existing buildings:g - �
Size of Mobile Home: 9'3 ft. by G' ft. Setbacks: front yard t-(r ft. rear yard Z- ft.
side yards 3E ft. and 27 ft.
Singlewide: Doublewide:/
Number of Rooms: (exclude baths) G Accessory Building(s): circle
Number of Bedrooms:
Number of Bathrooms: Detached garage: 1-car 2-car car
Circle: Gas Fireplace/Woodstove/Wood Fire lace Attached garage: No
2-car car ,
Foundation Support: Storage building: C✓ No - -("�`'
Type Size & Depth Other:
Piers
Water Supply: well orunicipal
Runners
6...0) 9-,5—CC-) 6 ^t Is Septic Permit Required? datillit ittiti
Continued on back
Ok Town of Queensbury • Community Development Office • 742 Bay Road, Qtteensnttn,, iv r iiou
*
Name of Installer or Mobile Home Dealer: �el 4� �h.t�
Address: 3 2- `"�r 1qi-21 ' , P `'<0- /�a
c.e-4 Sb—/ Phone: CV 7—7 719
Complete information below found on a"Plate"or"Sticker"which is affixed to the mobile home:
✓ Insignia serial number: ill —0— ! ,;I' 2 7 2
✓ Name of manufacturer: f1//ci' Yi Silo
✓ Plan Approval Number:
✓ Model or Component Designation: Ws5cr
� (New home only)
✓ Date of Manufacture: q— ( (1- -g8
C_r—g 8
AFFIDAVIT
i
Town of Queensbury State of New York
County of Warren
y
J
J
I swear that to the best of my knowledge and belief the ti
statements contained in this application, together with the plans
and specifications submitted, are a true and complete statement il
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, whet - -pecified or not, and that such
work is authorized by the • n- .
/ J
Signature:
Owner, ••wner's Agent,Architect, Contractor 4.
J
J
r
SPECIAL CONDITIONS OF PERMIT
By:
Code Enforcement Officer
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
RE ,'ED -7/00y)
rim Os /,[306 C y
TOWN
;b6ORY D e
BUILLA Pad ION FOR PLACING A MOBILE HOME � ; 6
OUTSIDE OFA MOBILE HOME COURT:
This application for a Mobile Home Permit shall be accompanied by a plot plan •
drawn reasonably to scale showing all dimensions, the size of the lot, the location on
the lot of the Mobile Home, the water supply and sewage system. If the applicant is not the owner of the
premises, then the application must be accompanied by the written acknowledged consent of the owner.
Applicant Information / Property Owner Information
/J
Name: /�c3r�ajc orPAax-tse Name: ku1t" /WufotiS�
Address: r 2 Mens-3eAddress: 3 t /44,%tnJ O
Queelfkr--f . /1-'1 /2-I°' 4ft r/
Phone No: -d )7 -r3 Phone No: —
Parcel Information
Property Location: 32- 114t yr 2j a-{cr /74--- Tax Map Number:
Road,Street,Avenue
Mobile Home Information
Approximate Value of Home: $ r'L NO, New Home: Yes
Replacement Home: No Size of Mobile Home: 7-2 ft. by CO ft.
Singlewide: Doublewide: Year: g%r Make: Mao .a r ctd�
Model: <) (I-ST Serial # ' O l•S-c)-2 2
State fully the reasons for this request: T ep(5c.}2_ $V1,19/€ /fit/
I/ ne k--v- k. -t'i O.t -9-47A'711.149 pace o1C'fr2i /'1j�O;
Applicant's Signature Date 3. 06
ca Town of ueensbtrn • Community Development Office• 742 Bay Road, Queensbury, NY 12804
AFFIDAVIT
Town oQueensbury State oNew York •
County of Warren
:..• I swear that to the best of my knowledge and belief the
F.,. 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 ;"
fj that all provisions of the BUILDING CODE, the ZONING
ORDINANCE, and all other laws pertaining to the proposed work
shall be complied with, w - er specified or not, and that such
work is authorized by e ow er.
Signature- „jr.A.I
•
• Owner, Owner's Age , 147 hitect, Contractor Date
FOR TOWN USE ONLY
Report of the investigation of the Zoning Administrator and recommendations:
APPROVED:
DISAPPROVED:
OTHER RECOMMENDATIONS:
ACTION OF THE TOWN BOARD:
APPROVED:
DISAPPROVED:
OTHER RECOMMENDATIONS:
By Resolution Number: of the Town Board of the Town of Queensbury,
Warren County, New York.
Dated this day of , 20
Town Clerk, Town of Queensbury
tl Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
r
OFFICE USE ONLY
TAX MAP NO. PERMIT NO. PERMIT FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. (� A A ' `,� `
OWNER: P1 Cr)Af Irl l J 1"IC`2iE1-e t))')E_ INSTALLER:
ADDRESS: 32- Np INLO E b 5V \ VE_ADDRESS: 32_ M t'A31JE�o-A ROE ,
PHONE NOS. � - 775-3 PHONE NOS. 5c-67--1-7c'3
LOCATION OF INSTALLATION: V Z M t Ik1 ) ,_51-v-f\ A \j E.
I NO.OF ' RESIDENCE INFORMATION:
YEAR BUILT BEDROOMS , X I COMPUTATION= = i TOTAL DAILY FLOW
�� GARBAGE GRIND)
1980 or older X [ 150 gallon per bedroom = INSTALLED? tJ
1981 -1991 'Z_,/ X 130 gallon per bedroom = Z � SPA OR HOT TUB
i 1992-present I l X ( 110 gallon per bedroom = ✓ INSTALLED? ►�O
PARCEL INFORMATION: /
✓ TOPOGRAPHY: FLAT '()LUNGV STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? tJ BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL V WELL
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH (TEST TO BE
COMPLETED BY A LICENSED PROFESSIONAL ENGINEER OR ARCHITECT)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by
a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK: LOCO GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH S-0 FT.
✓ TOTAL SYSTEM LENGTH: lo(T FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: # -2- /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM: (If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL.
11 NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
11 APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
•
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any
permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or
failure to make a material fact or circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this application and
agree to abide by these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codesQqueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburv.net
Signature of Person Responsible Date
.;s.t Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
iAc
FINAL INSPECTION REPORT J
MOBILE / MOOULAR •
Town of Queensbury
Building & Code Enforcement
742 Bay Road Com"
n. y 1 c' Queensbu(518)
61-N82561
I
ARRIVE: DEPART: INSP:
DATE INSPECTION -2a06-719(
SPECTiON REQUEST RECEIVED:
NAME: �
LOCATION: Vit.() {:IC ^ '��\ -ti`CG VO
DATE: ✓ ()l r PERMIT I/
MOBILE HOME MODULAR HOME
FOO'T'INGS_ FOUNDATION _ BACKFIU. FRAMING
N/A , YES NO
L foundation support, pier spacing
per manuf. — — —
2. anchoring per manuf. — — —
3. water line shut off
4. sewer line support ®4 feet — — —
5. heating crossover (dblewide) off grd. — — —
6. dryer vented outside7. skirting ventilated — —
8. hot water relief valve piping outside — — —
9. deck, porches, steps, railing — —10. furnace/hot water operating — —
11. garage fire proofing — — —
12. door closers
13. plumbing fixture — —14. foundation insulation (if appl.) — — —
15. smoke detectors — —16. final electrical
17. variance required
18. data plate okay — — —
i 19. mobile HUD seal okay
Model # Serial # Ne,f ',
Manufacturer •_
)�nn/J
Date of Manufacturer YJ'l 4
OKAY TO ISSUE CIO YES NO
Co•
mments: C. � \'�' i �-.` c• .)`
P
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<<3(6
Foundation Inspection Report
Office No. (518)761-8256 Date Ins.ection re, -- 4:
Queensbury Building&Code Enforcement Arrive: # T4ADepart: af_4:1*
742 Bay Rd., Queensbury, NY 12804 Inspector's Initia s:�
NAME: 'A )REl-i)F ERMIT#: 7 Cd4—10 LO
LOCATION: (3? M t tJ t.]EAGA A J E INSPECT ON: — 1-7- 0
TYPE OF STRUCTURE:
Comments
N N/A
Footings
Piers
ak Monolithic Slab t►
�0
* Reinforcement in Place Ftge_R.h *\
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site. I
Foundation/Wallpour
Reinforcement in Place
Foundation Dampproofing
Foundation/Waterproofing
Type of Dampproofing/Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\SuclHemingway\Building.Codes.Inspection.FORMSWoundation Inspection Report.doc January 28,2003
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
�``��(518) 761-8256
ARRIVE: (() DEPART: JO l—MP-
DATE INSPECTION REQUEST RECE E .
•
NAME: V
LOCATION: C 1 Ni1 i 6OTQ /Li E
DATE: — - PERMIT if )(c—IOc
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION BACKFILL FRAMING
N/A YES NO
1. foundation support, pier spacing
per manuf. — ✓
2. anchoring per manuf.
3. water line shut off
4. sewer line support ®4 feet
5. heating crossover (dblewide) off grd. t _
6. dryer vented outside ...
7. skirting ventilated
8. hot water relief valve piping outside
9. deck, porches, steps, railing
10. furnace/hot water operating
11. garage fire proofing _ _
12. door closers
13. plumbing fixture _ _ —
14. foundation insulation (if appl.) _
15. smoke detectors
16. final electrical
17. variance required
18. data plate okay
19. mobile HUD seal okay
Model # Serial #
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES /NO
Comments:
‘1) Th 1AllARcL.0 b\AIV--k1�
6E_ `\ \)EccrF om . )1Q 1
Septic Inspection Report
Office No.(518)761-8256 Date Insp ction request received:
Queensbury Building&Code Enforcement Arrive: A 3 J am/pmDepart: am/pm
L'/
742 Bay Rd.,Queensbury, NY 12804 Inspector's Initials: !
NAME: PERMIT NO.: A £ _
LOCATION: 3 Z �i�,,., INSPECT ON: .470
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance _ ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: _ x
Stone Size:
Piping Size Type _
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit _
Opening Sealed: Y/N/Partial
End Caps
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built —Y —N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use tus:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
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r—�—.-- - --- — -
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D i� �
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r-• _:� eiv�••
Queensbury Building &Code Enforcement Arrive: .I= 4r7!,•= %-•• : ..._2
742 Bay Rd., Queensbury, NY 12804 Inspector's Initi. . —
NAME: — PERMIT NO.: v 6- /0
6
LOCATION: ��fkle-r
So G� /,
INSPECT ON: /Z.—`F c4
RECHECK: eEM12/0 3-c O
Comments and/or diagram "\
Soil Type: Sand/ Loam / Clay
Type of Water: Municipal/ Well Water tc5v e RD\
Waterline separation distance ft.
Well separation distance ft. F1�61-k 1--_�A67" 1 1 OE
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft. _ 1 TIAL L.. Sc {) u v ELu.S
Depth of trenches _ ft.
Size of Stone — P��v DE M�s 1 L—�-- DtJ
Seepage Pits: Number
Size: x----
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field / Pit
Opening Sealed: Y/ N/ Partial
End Cap
Inlet/Outlet Pipes &Baffles ____Y_,_,-N '
Location/ Separations z.La5f Z.. . /' :`
Foundation to tank ft. P —
Foundation to absorption ft. ' `'
IN
Separation of Pits ft.
Conforms as per Plot Plan ,t._.Y_____ N
Engineer Report and As-Built '3 6EPRO0
Y—N µa F
Location of System on Property:
Front Rear Left Side Right Side
Middle Fro t Middle Rear )
S -m U - •tu .
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
1 r ,..1 ii :,LS) /IA r Q 4
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FILE co1 .) .1 REVIEWED B , Ase,, , .14//. 4
c..i.- it),. .--,.x2ininationt DATE A rillint re r
.c,7 wirr:01.1,cie. rnanisshal;
ntV i-,tenstruee -,-g... Indicating the
dspecificaiions are in full.
'VON,: Otte Raildinp Codes, 1 ;4°
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NOTICE 2 i
ANCHORING OF MOBILE HOME
FRAME IS REQUIRED PER L2J <,
kvcr- ,--MANUFACTURERS SPECIFICATIONS
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FINAL INSPECTION REPORT (tt e:.\
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road j'
Queensbury, NY 12804 (77;'
(518) 761-8256
y � fi/
ARRIVE: DEPAR1-1 1 )
DATE INSPECTION REQUEST RECEIVE : 077 / 7 31
NAME:
P\CT))/-1 /4)43
LOCATION: 3c� J 14(/1 n ./ l '�y�
DATE: /�— 1 0 / PERMIT ltxt-�6-16 K� J
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION _ BACKFILL _ FRAMING
N/A . YES NO
1. foundation support, pier spacing
per manuf.
2. anchoring per manuf.
3. water line shut off a>d./
4. sewer line support C43 4 feet
5. heating crossover (dblewide) off grd. 7,
6. dryer vented outside
7. skirting ventilated
8. hot water relief valve piping outside
9. deck, porches, steps, railing _ J/
10. furnace/hot water operating _ \J
11. garage fire proofing ✓�
12. door closers
13. plumbing fixture _
14. foundation insulation (if appl.) — J
15. smoke detectors
16. final electrical
17. variance required
18. data plate okay711/
— —
19. mobile HUD seal okay
Model # Serial #
•
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES V NO
Comments:
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
CIPPA CERTIFICATE - ELECTRICAL APPROVAL/C(
Permit No.... Cert. N 9 3 1 8 1 Cut-in Card No
Owner MO/26.-A-74-S.&
Location 3Z outf se 5 r' C/
Installation Consisting of /hI447
Installed By 51/411/19— Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of ma..': inspections at any time, and if its
rules are violated,the Company shall have the right t r oke Arertifc. e.
Date 1 g INSPECTOR.. i/
40,
Member N.F.P.A.,I.A.E.I.
/SCO
'INAL INSPECTION REP RT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART: $LA SP.
DATE INSPECTION RERIJEST RECEIVED
( 1
NAME: I C ^• •
LOCATION: \...ice /c
r
DATE: f //—O8 PERMIT II t.
MOBILE HOME MODULAR HOME
FOOTINGS _ FOUNDATION _ BACKFILL _ FRAMING
N/A YES /NO
1. foundation support, pier spacing
per manuf. _ �r /
2. anchoring per manuf. — •f/ ^ •
3. water line shut off _ ✓/
4. sewer line support 4 feet
5. heating crossover (dblewtde) off grd. f _
6. dryer vented outside ... 7
7. skirting ventilated
8. hot water relief valve piping outside _ • / —
9. deck, porches, steps, railing
10. furnace/hot water operating J /
11. garage fire proofing
12. door closers ✓ _
13. plumbing fixture
14. foundation insulation (if appl.)
15. smoke detectors
16. final electrical _ —
17. variance required
18. data plate okay _19. mobile HUD seal okay
Model if Serial#
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O 1 YES NO
Comments: V ,MTV o ` „r_,i " AV�+ -
7-' ! \M \ - >
3;2- ! ",fon_t ft) iG
Apo!ication
i;4 0 1C -- i- -) .-7
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Zoning Admin—istr ': f
1OMi^`�'UEENSE:;R`'
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