2006-834 giak TOWN OF QUEENSBURY
E474.Z411
VFW 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20060834 Date Issued: Thursday, March 01, 2007
This is to certify that work requested to be done as shown by Permit Number P20060834
has been completed.
Tax Map Number. 523400-309-013-0001-010-000-0000
Location: 35 INDIANA Ave
OwnerVIRGINIA ELLIS
Applicant: ROBERT & BARBARA MALLANEY
This structure may be occupiec%wtrkEY & VIRGINIA ELLIS
Mobile Home Out of Park By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the C
property owner of the responsibility for compliance with Site Plan, p ,ge)t-
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUE ENSBURY
Iwo 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060834 Application Number. A20060834
Tax Map No: 523400-309-013-0001-010-000-0000
Permission is hereby granted to: ROBERT&BARBARA MALLANEY
JEFFREY&VIRGINIA ELLIS
For property located at: 35 INDIANA Ave
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: ROBERT&BARBARA MALLANE
29 INDIANA Ave Mobile Home Out of Park $15,000.00
QUEENSBURY,NY 12804 Total Value $15,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2006-834
mobile home outside of park
$38.84 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, February 05,2008
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To of ensb , lidl , February 05,2007
SIGNED BY ''v for the Town of Queensbury.
Director of Building&Code Enforcement
I '•• r
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•
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TAX MAP NO. 30/ 1•3RMIT OFICE USE O�ON�` /.
ISSUED: , •
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�J}/l ' I:ECEJVED
PERMIT1E E 39)PROVALS: ZONING TOWN CLERK ' ' •
NOV 1 •
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°rOUVNOF 0113,`
ZONING OFFICE URY
MOBILE HOME -APPLICATION FOR PERMIT:
A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a
valid building permit has been issued.
Applicant Information Property Owner Information
Name: ,Jeiri Cy .1- Vi/8,,1..0 e1/,'5 Name: .7 A4 ( , /u1Q/ 4
Address: 8 T ,1,\i ct' L 4°/ Address: 2' 9 _Z-",,,c4:44.9 a/L
apeA5 b,,ey N I /2(4-'0 / aucens 1x� Al, y' /z8o /
Phone No. 6-71P) 793- / 923 Phone No.
Parcel Information 35
Proposed Date of Placement: i i j'?fl f O 4, Property Location: f" l rr0l'4n/a / -.t,
Road,Street,Avenue
Name of Mobile Home Park: (if applicable) Tax Map Number: 309 -/3 /-/d
Mobile Home Information Zoning Information
Approximate Value of Home:$ J/5""oer2 eo Zoning Classification:
New Home: Yes No Size of Property: /Z.0 gft. by S6 ft. b y (GO
Replacement Home: Yes No Existing buildings: Il C,oS GICIc0 Q
Size of Mobile Home: /,-/ ft. by 910 ft. Setbacks: front yard 3g ft. rear yard 'YO ft.
side yards 10 ft.and 3 9 ft.
Singlewide: X Doublewide:
Number of Rooms: (exclude baths) J Accessory Building(s): circle
Number of Bedrooms: �-
Number of Bathrooms: l sZ Detached garage: 1-ca 2-car car
Circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1-car 2-car car
Foundation Support: Storage building: es No
Type Size & Depth Other.
Piers `'
�Runner� �( 6 Water Supply: well or(municipal
Slab Is Septic Permit Required? Yes or No
I
Continued on back
AbA
. Town of Queensbury • Community Development Office • 742 Bay Road, Queensaury, iv r lzal14
(COrn t)5 rn ;
Name of Installer or Mobile Home Dealer. IIVIG f r i S corn,
Address: V G.(1 D(.& er- , tom.eerf5 /Phone: 71a - 57.5r
Complete information below found on a'Plate'or-Sticker which is affixed to the mobile home:
✓ Insignia serial number: 19 - 9'4 - 31(-1 - 9Y0(01
.✓ Name of manufacturer: V +Q
•
I Plan Approval Number:
✓ Model or Component Designation:
Z 51 �Aly home only)
• Date of Manufacture: y
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AFFIDAVIT
V
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Town of Queensbury State of New York
County of Warren
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
c 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
s work is authorized by the owner
Signature: �. /WYt�, -- Owner's Agent,Architect,Contractor
i
SPECIAL CONDITIONS OF PERMIT
•
By:
Code Enforcement Officer
Tour of Queensbury• Community Development Office• 742 Bay Road, Queensbury, NY 12804
FINAL INSPECTION REPORT
MOBILE. / MODULAR
Town of Queensbury
Building &Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART:
DATE INSPECTION REQUEST RECEIV'r '
NAME: /
LOCATION: ____SE \K)O f tA___
DATE: _ — —• PERMIT I_0_6::2371
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION _ .BACKFILL FRAMING
NIA 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. .
6. dryer vented outside .
7. skirting ventilated
8. hot water relief valve piping outside
4 9. deck, porches, steps, railing .4. /
10. furnace/hot water operating Y
11. garage fire proofing ��.�
t12. door Amer* ... {�
13. plumbing fixture
77--
14. foundation insulation(if apps.)
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 CIO V YES. NO
Comments:
rINAL INSPECTION REPORT d-q
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement 4?' Al -1 4--
742 Bay Road
Queensbury, NY 12804 ',. I
(518) 761-8256 / , e' e
ARRIVE: \74 bEPART: I),-II',PN.'• ' rIII --1 /
DATE I ECTION REQUEST RECEIVED: '1/)-''
�G 7
NAM . #--e &ILI s 1
� �
LOC ION: r� .-}' ~�`l,_e
l
DATE:(c7-7 G' / /W PERMIT tx- '--�`3 J
MOBILE HO E J" 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. i -
—
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 / f
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: Q -g')1 �' LAKW,1 ,v
fki— ILip1,=c u; 12- k---tE:? , i1E1,4
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Foundation Inspection Report
1 f /
Office No.(518)761-8256 Date Ins •on request rrceiv ,
Queensbury Building&Code Enforcement Arrive: /l-v= m, ' .
Depart: ? �- -
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
/n
NAME: " ) P,ERNIIT#: -8- V •
INSPECT ON: -1,7—t7
LOCATION: � �.� ��� � 7..-- j
TYPE OF STRUCTURE:
Comments
7
Y
i' NLA_
Footings ;-)41---
Monolithic Slab
Reinforcement in Place QM-t= R-U cL tJE?_9
The contractor is responsible for /
providing protection from freezing � ����-� Q v v
for 48 hours following the placement /
CT-
of the concrete. v A 130 F �Q FILL-
Materials
l L,-
Materials for this purpose on site.
Foundation/Wallpour 11,\ TA I-LED Tiktlk?f_D
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofing
Foundation 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:\Buiiding&Codes Forms\Building&Codes\Inspectfon FormsVounda ion Inspection Reportdoc
Last printed 12/20/2005 9:24:00 AM
Septic Inspection Report
Office No.(518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: 3 f am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: 644)
NAME: PERMIT NO.: 6 - c3. -a
LOCATION: ---C T ) I Pe - INSPECT ON: NM s
RECHECK:
Comments and/or diagram
Soil TypeiKS. .. 4.4,•. Clay
Type of Water: _ ••::. /Well Water
P
Waterline se arms ance ft.
Well separation distance ft. �G`,
eg-4?-) e-4444Ard2A-
Other wells: . ft.
Absorption Field: Total length ft.
Length of each trench ft. ciAlt" '.)`")' 45'
Depth of trenches ,--t— ft. 1t \ 91?)`F
Size of Stone '.._.
Seepage Pits: Numberkll'ile, t/� 5tY
Size: x L
Stone Size: l2
Piping Size Type �' -L 3
Building to tank t'`
Tank to Distribution Box
�� 1
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial Cigi-146-33.0.
End Cas /-1-Nt
_Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
' i
Separation of Pits
Conforms as per Plot Plan /], Y N7N
Engineer Report and As-Built `1 Y N
Location of System on Property:
1-7ront ear Left Side Right Side
Middle Front Middle Rear
System Use Sta
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518)\761-8256
ARRIVE:// " EPART: INSP: Cj
DATE INSPECTION REQUEST RECEIVED:
NAME: --GG/
LOCATION: i f / //i/
DATE: Z if)&P PERMIT# LI, \0. ii
aligr
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. _
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 CIO YES NO
l—
Comments: (.77—A_,,D)
1l/d c /11°10 gf7'I4(-.
Cq4
4/6"r /A) i)(46(' (/C-‘
FINAL INSPECTION REPORT f''V
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
�J (518) 761-8256 c
ARRIVE!J �DDEPART: INSPV
DATE INSPECTION REQUEST RECEIVED:
NAME: J � C_�I
LOCATION: 35---1 //9-
DATE: I *4, O C� PERMIT# r-d(y�
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.
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 G- Ccc// ip� C v E S
f
FINAL INSPECTION REPORT
`
MOBILE- / MODULAR
Town of Queensbury
06-- Building &Code Enforcement
742 Bay Road
. Queensbury, NY .12804
(518) 761-8256
ARRIVE✓ DEPART: INS _ ..--6-- /
0.-' DATE INS ON REQUEST RECEIVED:
14
NAME: _ I l C _ /!
V 1
. \----—------ 1/\1' s i\ j'r'
LOCATION: tArI 0 %02*
rc� r
DATE: P 139 #: 0
MOBILE HOME MODULAR.HOME
FOOTINGS— FOUNDATION_ .BACKFILL FRAMING
NIA . YES NO
1. foundation support, pier spacing
Per manuf
2. anchoring per manuf.
3. water liar shut off
—
4. sewer line support 0 4 feet .
5. heating crossover(dblewide) off grd.
6. dryer vented outside .. .a::.
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 apps.)
15. smoke detectors.
16. final electrical 17. variance required •
. 18. data plate okay —
19. mobile HUD seal okay
Madel#/q,91-(>-
1q'4 /q- 9 # . -
Man
ufactwrer < < ��"<
Date of Manufacturer c V)
OKAY TO / :YES • • NO
124w 5
Comments: .
Pe,& R4N5 tocP - 0
pe.,„nztoo 5c,e 76,(-5,9-59