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2005-187 TOWN 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: P20050187 Date Issued: Friday, August 05, 2005 This is to certify that work requested to be done as shown by Permit Number P20050187 has been completed. Tax Map Number: 523400-309-009-0002-001-000-0000 Location: 97 ALPINE AVENUE Owner: HOMESTEAD VILLAGE L P Applicant: SUTLIFF LILA This structure may be 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: P20050187 Application Number: A20050187 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: SI ITLIFF LH,A For property located at: 200 LUZERNE 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. Type of Construction Value Owner Address: HOMESTEAD VILLAGE L P 4294 ROUTE 5 Mobile Home In Park $30,100.00 Total Value $30,100.00 CALEDONIA, NY 14423 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2005-187 LILA SUTLIFF &WILLIAM ELDRAN-97 ALPINE AVENUE 980 SQ FT 1998 REDMAN MOBILE HOME $60.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday,April 12, 2006 (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 Tow#'of Qu nsb f� T d� , A ril 12, 2005 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit— Mobile Home Town of Queensbwy, 742 Bay Road, Queensbury, NY 12804 (518) 761-8256 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 In .formation Office Use N ,I 1 �, File Permit No. Name: 04h/Address: aFee Paid - Reviewed BY:e� IVE RE QUQ�s U►-y u� fz�py _ _ - _--- Phone Norft4.::��U Apt ?005 Property Owner Information Parcel InformationOWN OF {IUEENSBURY �.gUILDING AND CODEL- Name: Proposed Date of Placement: 3S 16 _�'"'�- Property Location: ./ q7- 614p4le Address: Rojo, 1Avme Name of Mobile Home Park: YlAk( Cf applicable) LV� - fib - �'��� Phone No. Tax Map Number: Mobile HoQ Information -_ Zoning Information Approximate Value of Home: $ 30► 100 _ _ Zoning CIassification: New Home: Yes -p., Size of Property: �� �ft.by�it.Replacement Home: I& No I4 ?�C) , Existing buildings: �o�{ Size of Mobile Home: �ft. by �fL Setbacks: front yard fL; rear yard fL Singlewide: �_ Doublewide: Side yards &and ft. Number of Rooms: (excl de baths) Number of Bedrooms: Accessory Building(s): circle Number of Bathrooms: Detached garage: 1 car; 2 car, car circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1 car; 2 car, car Storage building: Yes No Foundation Support: Other. TYPE SIZE&DEPTH Water Supply: well or I Piers s Runners x Is Septic Permit Required? Yes or N� Slab x Further information requested on the reverse side of this sheet Name of Installer or Mobile Home Dealer. i Y_tle'0 Address: l�Jy y' E ,/v�� Z-92-9 Phone No. Complete information below found on a"plate"or"sticker"which is affixed to the mobile home. 1. Insignia serial number. 2. Name of manufacturer: - "'40 r/ 3. Plan Approval Number: 4. Model or Component Designation: j:?'t?Q p L� (New Home ONLY) 5_ Date of Manufacture: AFFIDAVIT — Town of Queensbiuy _.. ----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 d that such work is authorized by the owner_ Sigtature: er j gent, contractor Special Cone itio of Permit By Form: t 1/1911999sh Code Enforcement Officer Application for 1'crinit—Septic Disposal System 7 onvn (I`QNeellsbin))7.1213ay 1(oad Qu ensh NY 12804 (51 v) 761-5256 1 cw1 • ' ' j ply 1. OWNER INFORMATION: `' � i once use Location of installation: fLACs4r,,,4 U;/L z �.o� 97 tr.z�rv.o Roa�ct,�G2u..+.sb�.r7 File Permit No. Tax Map No.'s 9 / 2 / (� � • Fce Paid Owner's Natnc: ��YOf�ubIc �ta'f:b� Address: L1QZ,9 Ro�jt S _ Cc IC b,%jq";e,)0 79Z- 7ZS7 2. INSTALLER'S NAME ,,.fay �Pj„�� S��.fi PHONE NO.Zf�,Q�S© 3. RESIDENCE INFORMATION: (circleyear of dwelling, indicate #bedroom(y) and multiply it of bedrooms with applicable gallons per bet/room to equal total daily ho)n) Year of House: No. of Bedroogis x Counp station = Total Daily Flow 1980 or older 3 x 150 gal/bdrm = 1980— 1991 x 130 gal/bdnn = 1991 —present x 110 gal/bdrnt = Garbage Grinder Installed yes_ / no Spa or Whirlpool Installed yes___. / no 4. PARCEL INFORMATION: (circle applicable information & indicate measurements) _ ��hl► _ _ rp rpun� Water Bedrock or lnihcrvious MalcrialDotncslic._Watcr Suhhly �7cit send al what cleplh al u,lurl depth nurnictpal o irrg feel feet Nell Sleep slope clay if well; water supply slope other from any septic-system depth: absorption is ft. other _ Percolation Test: (To be completed by licensed profi,,.ssional engineer or(irchitect) J Kate: _,minute per inch cjn/(�no►�'r 5. PROPOSED SYSTEM: For New Constntction: All individual sewage disposal systems must be dcsigucd by a licensed professional engineer or architect(unless installed in a Planning l3oard approved subdivision). Add 250 gallons to the size of the septic tank and leach Geld for each Garbage Grinder,Spa or Whirlivol'i'ub. Septic Tatrlc: jQQQ gallon (min. size 1,000 gal.) Se-0; ��„�� ®n�� ('t COh►%rcic-1{o Tile Field: each trench _ft. Total System Length:__ __fl• Seepage Pit(s): number of size of each: ft. by f1. j(xht�'tri o� eXis�;,,g Size of Stone to be used: i/ / depth or thickness /Let Mor:lout. Bed System Size: x Alternative System: length and/vr•size QQ --' o .crs ��GK 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work roust be inspected by a Town approved electrical inspection agencv. - 7 SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) For your protection,please note that pursuant to Section 136-29 of rho 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 Sanitary Sewage Disposal Ordinance. Z or Signature of responsible person ate , Septic Inspection Report Office No.(518)761-8256 Date Inspection re st re i d: Queensbury Building&Code Enforcement Arrive: m/p rt: a 'pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Ini als NAME: � ti�6-y �3 UAA--)E— IT NO.: Z-yC-s.'�-- LOCATION: M; SPECT ON: IC--. 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 ft• Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size T 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 P N Engineer Report an As-Built Y N Location of System on Property: Front Rear Left Side Right Side Middle Fro Middle Rear S stem Use St s• Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved Last revised 116105 Septic Inspectio*Rep Office No. (518)761-8256 Date Insed: Queensbury Building&Code Enforcement Arrive: epart:742 Bay Rd.,Queensbury,NY 12804 InspectoNAME: ��� �� � ..�� ll-> .: 2-C-,LOCATION: A- E)L kl 1;=i k\ � : C1 RECHECK: Comments and/or diagram Soil TypqCja o a Type of Water: uni ' ell 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 ft• Size of Stone Seepage Pits: Number Size: x Stone Size: Piping ASize Type Buildingto tank Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/N/Partial Location!Se arations Foundation to tank ft• Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y Location of System on Propert Front Re< Left Sid�it Middle Front Middle Rear System Use Sta us: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LASueHemingway\Building.Codes.inspection.FORMS\.Septic inspection Report.doc January 28,2003 FINAL INSPECTION REPORT I ' MOBff.E / MODULAR ......... Town of Queensbury Building & Code Enforcement piled 742 Bay Road Queensbury, NY 12804 Pe r. er- (518) 761-8256 � l ARRIVE: DEPART: Ifc ,r DATE INSPECTION REQUEST RECE NAME: LOCATION: �- � � L � DATE: U PERMIT#c;WS'/87 MOBILE HOME MODULAR HOME POO'TINGS FOUNDATION BACICRU 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. fiumce/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 IS C/O YES NO Comments: FINAL INSPECTION REPORT MOBILE / MODULAR Town of Queensbury �Ui Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: DEPART:/b (ANSP: v DATE INSPECTION REQUEST RECEIVED: NAME LOCATION: C�✓l DATE: S PERMIT 1/ QU5 I MOBILE HOME MODULAR HOME FOOTINGS FOUNDATION RACKFILL 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 a 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 #'?3"✓ 1D Serial# ZZ ManufaOurer Date of Manufacturer 3 OKAY TO ISSUE C/O YES _1,"NO Comment "O O pC N Az- �L /QA A I FINAL INSPECTION REPORT MOBILE / MODULAR Town of Queensbury Building &Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: DEPART: INS DATE INSPECTION REQUEST RECEIVE NAME: LOCATION: NVAPI"'-D � DATE: -1 �' ��s PERMIT!t ^� IVQ MOBILE HOME MODULAR HOME FOOTINGS FOUNDATION RACKFUI L 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 # �r� 7)0 Serial# Manufacturer Date of Manufacturer OKAY YES NO L Comments: �� � G`(�� �/ � � .fit �'t�- r � ` �-��. � , �t'� � 0 t� �O� i �� , �, r epee-+�- ,��� �� � {���" t F +4 � �uj U-1 ., 20 O 4J' s Uj NOTICE -1:50 h ,�- ANCHORING OF MOBILE HOME U-z FRAME IS REQUIRED PER 3= MANUFACTURERS SPECIFICATIONS cc �,d 1 may^ z'BUILDING & REVI _ EWED BY T > K -OAT_.AN ., . ... T07 IN OF QUE�NSBURY BUILDING DEPARTMENT n our limited examination, compliance with our comments shall L not be construed as indicating the compliance th hehe B lding Codesl �1^/ C of New Yogic State. FILE COPY