RC-0082-2018 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-0082-2018 Date Issued: Monday, October 22, 2018
This is to certify that work requested to be done as shown by Permit Number RC-0082-2018
has been completed.
Tax Map Number: 308.6-1-67.2
Location: 38 WARREN LN
Owner: Maegan Gillis
Applicant: Maegan Gillis
This structure may be occupied as a: Manufactured Home w/septic 28' x 56'
Cross Ref. Z-AV-22-2018 approved by ZBA on March 21, 2018 for setback reli By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
p Y
property owner of the responsibility for compliance with Site Plan,
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
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
4VL Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: RC-0082-2018
Tax Map No: 308.6-1-67.2
Permission is hereby granted to: Maegan Gillis
For property located at: 38 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
Tvne of Construction
Owner Name: Maegan Gillis Mobile Home $85,000.00
Owner Address: 38 WARREN LN Total Value
$85,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
ML Contracting
34 Warren LN
Queensbury,NY 12804
Plans&Specifications
Manufactured Home w/septic 28'x 56'
Cross Ref.Z-AV-22-2018 approved by ZBA on March 21,2018 for setback relief
$ 1,163.60 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday,March 26,2019
(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 Town ue ury; �Mo 26,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
IT ;*s.
Office Use Only
ONES MANUFACTURED HOME Permit#: 1Zr- '00�2--ZV4-
PERMIT APPLI�� I ( E Q W "IN 1iJ Fee:$ I (d C'
Torn of Queensbury 11
742 Bay Road,Queensbury,NY 12804 FEBq o t - Fe'. $ '�� +e) it d&
P:518 761-8256 www.queensburv.net B 2 v 2 , I C•���/a�3,^'1�0��
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TOWN OF OUEENSOURY
BUILDING&COD s
Project Location: Wac rC>(1 Laa U Tax Map ID #: 36S-. — ( - ln1 ,J
Name of Park: -N� _ �`��, Proposed Date of Placement: ' `1"A
CONTACT INFORMATION:
• Applicant:
Name(s): M( P(1 o C7 1 i
Mailing Address, C /Z: a
Cell Phone: 10-7 Land Line: ( )
Email: nr���: no`►)y.6 011 �, orrb i 1,t'nm
• Primary Owner(s):
Name(s): m
Mailing Address, S/Z: C, 4
Cell Phone: ( 519" a&`1 Land Line: ( )
Email: �MCtPC )1 c S o?C3 -1 ►1 .rom
• Contractor(s): `
Business Name:
Contact Name(s): r1l& CJ
Mailing Address, C/S/Z: 3� Q�(1 Lam I
Cell Phone: �((rik Land Line:
Email: le
lot W-,50 (a q tno i . Pnrn
Contact Person for Building & Code Compliance: 5c;c', &, G�Ve
Cell Phone: ( ) Land Line: ( )
Email:
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017
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MANUFACTURED HOME INFORMATION:
(INFORMATION FOUND ON THE PLATE OR STICKER LOCATED IN THE HOME):
Insignia serial #:
Name of Manufacturer: 1 A kA
Place approval #:
Model or component designation (New Home Only): 3
Date of manufacture:
ADDITIONAL INFORMATION:
1. Approximate Value of Home: $ s a`-f)
2. Is the home NEW Zor a REPLACEMENT ?
3. Single-wide or Double-wide- Size: 07_&_ft.X r t ft.
4. Foundation support(choose one): Size Depth
Piers:
V Slab:
5. Is the home being placed on a private lot? No Yes_Z(if yes,you must provide stamped engineered
drawings of the permanent foundation plan)
6. Total#of rooms(exclude bathrooms): ;#of bedrooms: ;#of bathrooms: e�2
7. Additional heat source? No—Z Yes Choose one, if yes: gas fp_ woodstove_ wood fp
8. Are there any other/existing buildings on the property? Noes ; Explain:
9. What is the water source? PUBLIC PRIVATE WELL
10. Is the parcel on SEWER or a PRIVATE SEPTIC system? 1pr llvcckt "'tom
. I L
11. Do you need a septic permit application? No Yes
DECLARATION:
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 NYS Building Code,the Zoning Ordinance and all other laws pertaining to the
proposed work shall be completed with
I have read and agree to the above:
PRINT NAME: —r ,�1ra5
SIGNATURE: VvW=gw �toJ DATE: a
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017
SEPTIC DISPOSAL PERM se Only
AW 742 Bay Road,Oueensburry,NY 1 C E a 1�6
P:518-161-g256 www.pueens n L .
Tax Map ID#: - I - I;o1 . ,� FEB 2 b 201 t Tee:$ ; Invoice#:
Project location; NSIWic Variance? Yes No
Primary owner(s) -
t3U1LUINU!ic t,:UUtti �
Mailing Address
Phone & Email
201
Installer/Builder -
Mailing Address J
Phone & Email
Engineer
Mailing Address
Phone & Email
Contact Person for Building&Code Compliance: Phone:
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder I Yes IV9
1980 or older I I Installed. circle one)
1981-1991 I I Spa or Hot Tub I Yes No
P 1992-Present Installed? (circle one)
� I I
PARCEL INFORMATION: !
Topography Flat Rolling Steep Slope %Slope +�
Soil Nature X Sand Loam Clay Other
Groundwater At what depth? �J 0
Bedrock/Impervious material At what depth? 00
Domestic Water Supply I X Municipal —Well (if well,water supply from any septic system absorption is_ft.)
Percolation Test I Rate: per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size 11,E gallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone I Total length IA16 ft.; Each Trench 36 ft.
Seepage Pit with#3 stone How many: ;Size:
Alternative System Bed or other type:
Holding Tank System Total required capacity? ;tank size ;#of tanks
NOTES: 1.Alarm system &associated electrical work must be inspected by a Town approved electrical inspection
agency;2.We will no longer allow systems to be covered until such time as an as-built plan is received and approved.
The installed system must match the septic layout on file—no exceptions.
Declaration:Any permit or approval granted which is based upon or is granted in reliance upon any material
representation 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 and agree to abide by these and all requirements of the Town of Queensbbry Sanitary Sewage
Disposal Ordinance.
PRINT NAME; 1 �►S DATE: oZ S I
SIGNATURE: DATE:
Town of Queensbury Building&Code Enforcement Revised February 2017