2011-544 TOWN OF QUEENSBURY
742 Bay Road, NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110544 Date Issued: Saturday, December 31, 2011
This is to certify that work requested to be done as shown by Permit Number P20110544
has been completed.
Tax Map Number: 523400-308-006-0001-069-000-0000
Location: 20 WARREN Ln
Owner: RICHARD G HIGGINS
Applicant: RICHARD G HIGGINS
This structure may be occupied as a:
Mobile Home In Park
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the ( eivAP 1/j / .
property owner of the responsibility for compliance with Site Plan, /d
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 QUEENSBURY
ET 4y 742 Bay Road,Queensbury,NY 12804-5902 {518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110544 Application Number: a20110544
Tax Map No: 523400-308-006-0001-069-000-0000
Permission is hereby granted to: RICHARD G HIGGINS
For property located at: 20 WARREN Ln
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: RICHARD G HIGGINS Mobile Home In Park $38,000.00
PO BOX 931 Total Value $38,000.00
GLENS FALLS,NY 12801
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2011-544
54 x 13.4 sq ft mobile home
$90.72 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, October 31, 2012
(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 therv-vh-of9ue91.1s/hu7i; tniguittir October 31, 2011
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
• 30g10-4-0 OFFICE USE ONLY
TAX MAP NO. PERMIT NO. i(—Pf Vv DATE ISSUED:
PERMIT FEE APPROVALS: ZONING TOWN CLERK ! `� 2-R-7/
,
i
-"y♦
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: R 1 C/LCQ-t'd( (7c) f filpihjlame:
Address: Po, 13o x / / • Address: Sa )r?r -�.
6 enc A715 , /t1. .
l' - i
Phone No. 67 ✓ / 0 /(-) 17 / Phone No.
Parcel Information
20
Proposed Date of Placement: _,� r~
� Property Location: lorre►r . --lti
Road, Street, Avenue
Name of Mobile Home Park: (if applicable) Tax Map Number: 30?. 6._
Mobile Home Information . Zoning Information
Approximate Value of Home: $ }8; 000 Zoning Classification:
New Home: Yes No Size of Property: ft. by ft.
Replacement Home: lell No Existing buildings:
Size of Mobile Ho 5/ ft. by 131it. Setbacks: front yard ft. rear yard ft.
side yards ft. and ft.
Singlewide: Doublewide:
Number of Rooms: (exclude baths) Accessory Building(s): circle
Number of Bedrooms:
Number of Bathrooms: Detached garage: 1-car 2-car car
Circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1-car 2-car car
Foundation Support: Storage building: Yes No
Type Size & Depth Other:
Piers Water Supply: well or municipal
Runners
• Slab $`4 _ /304i • Is Septic Permit Required? Yes or No
Continued on page 2
Town of Queensbury• Community Development Office - 742 Bay Road, Queensbury, NY 12804
Revised March 2010
Name of Installer or Mobile Home Dealer:
Address: Phone:
Complete information below found on a "Plate" or "Sticker" which is affixed to the mobile home:
✓ Insignia serial number:
✓ Name of manufacturer:
✓ Plan Approval Number:
✓ Model or Component Designation:
(New home only)
✓ Date of Manufacture:
AFFIDAVIT
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 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, that such work is authorized by the owner.
Installer Warranty will be prov deb ime Certificat: of Occupancy.
)4 -Signature: �-
'Owner, Owner's Agent, Architect, COI ra tor
SPECIAL CONDITIONS OF PERMIT
By:
Code Enforcement Officer
dok Town of Queensbury- Community Development Office - 742 Bay Road, Queensbury, NY 12804
TOWN BOARD APPLICATION FOR PLACING A
MOBILE HOME
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
Name7RV Y \\IC ( 11,1,3 Name lQWed) GUY V\1 C ! A-. 1
Address: c.L- 'O'( q 1 Address: e6. obX 93
Nems ,
Phone No: C. � 1-440 ` I Phone No: u — I 104-k 1(98)
Parcel Information
Property Location: c:9-O Tax Map Number: ,
Road,Street,Avenue
Mobile Home Information
Approximate Value of Home: $ New Home: Yes No
Replacement Home: ..Yes No Size of Mobile Home: 5(- ft. by ) 3.Lft.
Singlewide: Doublewide: Year: at ( Make: QIIR ti' ?i ON)
Model: S4-S Serial #
State fully the reasons for this request: )'-)
Applicant's Signature Date
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
Revised March 2010
AFFIDAVIT...
i e
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
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.
l�Signature: �'`.. �i ic,A0 O--- al
Owner, Agent, Architect, Co• .ctoc 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
Town of Queensbury- Community Development Office • 742 Bay Road, Queensbury, NY 12804
Revised March 2010
+• Revised 4/14/2010
. 1 iVillei
OFFICE USE ONLY , x
. (. ?r (, /
TAX MAP NO. PERMIT NO. JPERMIT 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
ISSU OFcA�VALID PERMIT. P f '
OWNER: "t q-�1�5►►{J @ J Y �� IIJCI 1 vV� INSTALLER: m L CCS/171R , .-'3 �L.i&)
ADDRESS: V V -(..)i (_(_ 3 l ADDRESS: s`&?enn
PHONE NOS. (5( b LES'b -`11c., � PHONE NOS. d)'7 0 'f
LOCATION OF INSTALLATION: C94) 1` I?E N 1-41 V 1.----
RESIDENCE
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT = TOTAL DAILY FLOW °
BEDROOMS X (Gallons per bedroom) , GARBAGE GRIND p
1980 or older X 150 = INSTALLED?
1981-1991 X 130 = SPA OR HOT TUBIL)
)
19 -present eQ X 110 = — INSTALLED? �l!
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING A STEEP SLOPE %SLOPE
I SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? it/rO
I BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? /P°
✓ DOMESTIC WATER SUPLY: MUNICIPAL) WELL (If well:water supply from any septic system absorption is: ft)
/ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi]
(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).
TANK SIZE: //dOO GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder,spa or whirlpool tub.
SYSTEM TYPE: 4 (
,,,'ABSORPTION FIELD(WITH NO.2 STONE) Total length v?0 O ft. Each trench 1,C X 6 C I
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
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 Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sewage Disposal Ordinance. codes(cr?.queensburv.net
04;4 0 .. Ji) VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburf•net
Signature of Person Responsible Date _
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
Q °eensbury Building & Code Enforcement — Manufactured / Modular Final Inspection
}} z- A
Office No. (518)761-8256 Arrive: _am/pm Depart:l ° am/pm
Date Inspection request received: Inspector's Initials: /1 d int]
NAME: /1 r 11 Ci f ('\-4-S
PERMIT#: 5---- - '4
LOCATION: ,21Y `4)arr ,_ L._. DATE: /7 —(,--,
Manufactured Home
Modular Home
Footings Foundation_ Backfill Framing
Comments:
Yes o WA
Foundation support,pier spacing, l; / � I'�n0
Per manufacturer j
Anchoring per manufacturer 2'from ends ' / C)/1-e... / S AC) P1/4 ,
V
Water line shut off
Sewer line support @ 4 feet
Heating Crossover[doublewide}off grd. V /
Dryer vented outside i /
Skirting ventilated 1 so.ft.Der 1.500 so.ft. 4vf
Hot water relief valve piping outside i.'
Deck,porches,steps, railing
Fumace/hot water operating
Garage Fire proofing V1
Fire Door/Door closers
Plumbing Fixture/3"Vent through roof[Modular] \
Foundation insulation[rf applicable]
Smoke/Carbon Monoxide Detectors/Interconnected
Final Electrical
Variance required
Data Plate okay
Manufactured HUD seal okay 1\/
Warranty Seal after January 1,2006
Installers Warranty Seal /
18"x 24"access or 22"x 30"attic access
Vapor retarder under home 6 mil poly or other V --z., 7 iA
911 Street number
Okay to issue CIC or CIO[Temp./Perm.]
4)
Model#�L- '�0�� ( I Serial it 1,-X --1 -, i,, - W"c*
( ��
. 111 r
1
Manufacturer MAAV I ON
Date of Manufacturer
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/( /fl&i'dc .
Septic Inspection Re O rt
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/p rt: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: r
2 ,
NAME: f f G '`- r PERMIT NO.:
LOCATION: 2z, ir-P,i,—. /—i& INSPECT ON: MiMinv
RECHECK:
.c.... Comments and/or diagram
Soil Type: Loam / Clay
Type of Water: unicipa`{ Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length --yi.."6 ft.
Length of each trench :.J ft.
Depth oftrenches _"2- _ft.
Sizeze of Stone
Seepage Pits: Number _
Size: , x
Stone Size:
Piping S'ze T pe �`
Building to tank G U `Z-- `'
Tank to Distribution Box n`
Distribution Box to Field/ Pit `A 5 G<
J
Opening Sealed: _ N
End CapN
Inlet/Outlet Pipes&Baffles j/Y N
Manholes 12"or less below grade Y_N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank ft. `" .- S‘?, 1 D4A-'4" ; ""‘t- 4 -
Foundation to absorption '' eft.
Separation of Pits \ !I ft.
Conforms as per Plot Plan t` `, .N
Engineer Report and As-Built Y N
ETU Maintenance Contract Y_ N
provided
Location of System Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use S s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report03 29 10.doc