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2007-597 TOVN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 4z Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF OCCUP-A-N- CY Permit Number. P20070597 Date Issued: Monday, October 15, 2007 This is to certify that work requested to be done as shown by Permit Number P20070597 has been completed. Location: III AVIATION Rd Tax Map Number. 523400-295-018-0002-004-000-0000 Owner. IVAN & JANE BARSUKOFF Applicant: IVAN & JANE BARSUKOFF This structure maybe occupied as a: Mobile Home In 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, 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 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20070597 Application Number. A20070597 Tax Map No: 523400-295-018-0002-004-000-0000 Permission is hereby granted to: IVAN &JANE BARSUKOFF For property located at: III AVIATION Rd 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. Tie of Construction Value Owner Address: IVAN &JANE BARSUKOFF Mobile Home In Park $8,000.00 82 ROCK CITY Rd HUDSON FALLS, NY 12839 Total value $8,000.00 Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2007-597 MOBILE HOME IN PARK $43.20 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, October 15,2008 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the To of ctober 15, 2007 eens �„V/ n SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement a.r.........a..,.ara..aa...................... �!�I 'ET'V T'V IE OFFfCE USE ONLY D L� r, TAX MAP NO. RMIT NO. RATE ISSUED: ?p SEP 21 2007 ; PERMIT FEE APPROVALS: ZONING TOWN CLERK , 0 SOWLN'y OFy�M .�Es �U-s Y rrrr.rarrr,rr............r..r.raa..rrrar..a..a...................... MOBILE HOME -APPLICATION FOR PERMIT; A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a valid building permit has been issued. Applicant Information Property Owner Information Name: �� � }I25 w �j' Name: Z:4"zS Address: �rz &v ec e r—� lZv� Address: ff Z JZ o c-K e-rT y ~ Phone No. 5/�- 7 T-©ro S""' Phone No. �- gr, - 7 y 7 0Sd Parcel Information Proposed Date of Placement: `l - 7.7 7 Property Location: I I( CWoerwtA Zer�t i Road,Street,Avenue Name of Mobile Home Park: i,' ///6�lr�E �rs+ Tbte) Tax Map Number: Mobile Home Information Zoning Information Approximate Value of Home:$ Zoning Classification: New Home: Yes z Size of Property: ft.by ft. Replacement Home: es No 7Z O ' Existing buildings: Size of Mobile Home: �_ft. by ft t!� ' 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: 2 Number of Bathrooms:_1_ 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 € is Septic Permit Required? Yes or No Continued on bads Town of Queensbury• Community Development Office • 742 Bay Road, Queensoury, N Y 11-OW ♦ 1 ti a'nA Name of Installer or Mobile Home Dealer. 1 l a'a p C c, J 04 b�-,i Address: 96 y�,c s �NY Phone: .7 �f Complete information below found on a`Plate"or'Sticker which is affixed to the mobile home: Insignia serial number. L/9 t I ~ Z-707 C Name of manufacturer. Plan Approval Number: k 5TD i Sflg •� Model or Component Designation: C.J l 2 e-T -5-�-I Z (New home only) Date of Manufacture: Z T,.rsr�•-a�•-.r'.rr�-arr:r-.r-ra•-�^.ram ar:.^.rua�.r:r-�^.r-�•-�•�•:rs�•-�•aa'«•-.r'.rs_^.ru�.ru�•'.r:.^��•srr:r•:.^.trt:r.=a.; . AFFIDAVIT J Town of Queensbury State of New York Y c County of Warren c i I swear that to the best of my knowledge and belief the statements contained in this application, together with the plans x and specifications submitted, are a true and complete statement z of all proposed work to be done on the described premises and151 = 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 x work is authorized by the 78,A--A ner. s � G i •J• Y z Signature: x er, is en itect, Contractor M V �yy y ✓?l.'KliAi _Xliaw'a`✓:Jiw'►JJiKJ4'Ail:J.'J:.al.'4'JiJ:urY:MfY'+:+:+.-a1Va:wtal:.a:w.-•-•-_� _ •L"i`L_'lww:I:w'J:/`J:+:J: SPECIAL CONDITIONS OF PERMIT By: Code Enforcement Officer Toum of Queenslncry• Community Development Office• 742 Bay Road, Queenshury, NY 12804 L.ummunzEu yevecopment u ice y Town of Queensbury - 742 Bay Rd. Queensbury, New York -12804 PLOT PLAN lo Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines. SIDE PROPERTY LINE ...... r _ , f Ic l _ ` ... ..te .,�„ ...'.. Tii T_i.._. __ .____._ _ r 1 } I I I . ,.........; ....... '..,,. .�...__�..._.......-...�_.._J;._.�._1._...._F--...... .................. .�._.._.I O LU Z _.- __ --- .. _ .. i , I J �. i -_„ — : WWI I � I I — L-, j _._i...._a..._. ._ : , f 1 i L I y)yJC �.... i LLI _._..{ a ICr , I _I i . _} t or oiaiiAN -o.. [ I I t EIS ►I E I ' �r T 71NN-1- OF t�t'�EENSWR I tt°NSA_ i - cm�ance wi h o r c mm nts sha�! ... � T ! I not bO On as ndiatln ffie '' eQrt3pllanEs v�f I , SIDE PROPERTY LINE SQUARE = FT. o g5 O { U C f h r r + TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 518-761-8201 AFFIDAVIT TOWN OF QUEENSBURY STATE OF NEW YORK COUNTY OF WARREN I swear that the following used mobile home that will be transported into the Town of Queensbury for placement will have the following. A building permit approved and issued, meet all zoning requirements, the mobile home's HUD sticker affixed to mobile home and meet HUD requirements for the Middle Zone. As the person responsible for the transport and placement of this mobile home, I accept total responsibility for removal of the mobile home from The Town of Queensbury, if it does not meet the requirements for placement. Signature: Date: _ - Z ►- Cl 7 Yobile Home wner, O is Agent, Mobile Home Contractor Signature: - Date: Z Town of Queens ury Coide Enforcement Officer "HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE" SETTLED 1763 FINAL INSPECTION REPORT MOBILE / MC30ULAR r mown of QueenaKuy Building &Code Enforcement 742 Bay Rood Queaisbury, NY 12804 (518) 7614256 ARRIVE. --- DEPART:�---OINSP: DATE INSPECTION REQUEST RECEIVED: NAME: `�1M U,e� LOCATION: t it Ax,e 0i lh DATE: 7 PERMrr#,22Q67"Sig 7 MOBILE HOME MODUL" HOME FOMINGS FOUNDATM BACKFU L FRAMING N/A . YES O I. foundation support, pier spacing per manuf. _ 2. anchoring per manuf. 3. water line shut off ................... 4. sewer line support(0 4 feet ....... ` 5- heating crossover(dblewide) off gird. 6. dryer vented outside .x................... _ 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 # 1Z0 Serial# -b 11�==`cf�- Manufacturer Date of Manufacturer OKAY TO ISSUE C/O YE NO Comments: �- � _ COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. Main Office 176 Doe Run Road-Manheim,PA 17545 MUNICIPALL CERTIFICATE - ELECTRICAL APPROVAL .� ..Permit No. —7ce�rt. N 2 3 2 7 4 Cut-in Card No..................................... Owner........... v"PW l .f!4 u:..KaC ................... ............ .............. r ... Location...:�.T.�l. Tti .f CGZCl...lfl�...i— ................... .............. . .......................................�...�_ �" Installation Consisting of.A /�l G� c� r�lJ!G�..`..................................F'\.............. .................................................................................................................................................................................... .................................................................................................................................................................................... InstalledBy.......... ....................................................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 inspections at any time, and if its rules are violated,the Company shall have the right r ke this certifi e. —Q C Date.. Q.�;{,`o. ,,,,,,,,,,,,,,, INSPECTOR .... ....... .......................................................................... Member N.RP.A.,I.A.E.I. ' I FINAL INSPECTION REPORT MOBILE / MOOULAR Town of Queensbury Building & Code Enforcement 742 Bay Road Asbury, NY 12804 (518) 76141256 1 ARRIVE: DEPART:Mi INSP: DATE INSPECTION REQUEST RECEIVED: NAME: _Zr/a�. S� lI //I LOCATION (Yj DATE: PERMIT U D7 MOBILE HOME MODULAIII HOME FOOTINGS_ FOUNDATION BACKFRL FRAMING NIA YES NO I. foundation support, Pier spacing per umuf. ........................ 2. anchoring per manuf. ............... 3. water line shut off ................... — 4. sewer line support 0 4 feet ....... —_ 5. heating crossover(dWewide) off grd. S. dryer vented outside .x................... 7. skirting ventilated .................... 8. hot water relief valve piping outside — — — 9. deck, porches, steps, railing ........ 10. fiunace/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 # L All rial � � -Zl ' K Manufacturer ,�� Date of Manufacturer OKAY TO ISSUE CIO YES NO Comments: \31