2005-197 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
4E Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20050197 Date Issued: Thursday, July 28, 2005
This is to certify that work requested to be done as shown by Permit Number P20050197
has been completed.
Tax Map Number: 523400-308-006-0001-061-000-0000
Location: PETRIE Ln
Owner: SAMUEL & VIOLA WAHNON
Applicant: RODNEY & SHELLEY DURKEE
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: P20050197 Application Number: A20050197
Tax Map No: 523400-308-006-0001-061-000-0000
Permission is hereby granted to: R0DNF,Y& SHF,I J.F.Y DT 1RKF,F,
For property located at: PETRIE 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. Tie of Construction Value
Owner Address: SAM UEL & VIOLA WAHNON
39 SARATOGA ROAD Mobile Home In Park $45,000.00
Total Value $45,000.00
GANSEVOORT, NY 12831
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-197 LOT 53 PETRIE LANE RODNEY& SHELLEY DURKEE
28 X 40 SQ FT 2005 MOBILE HOME
$42.20 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, May 05, 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 T n of eens u day,May 05, 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 Information
Office Use
File Permit No.
Name: 900A)6V 151 if
Address: S3 Dv4j�5 64,t 64 al%p Fee Paid
Reviewed By:
t
Phone No.
Property Owner Information 47r� Parcel Information
Aj CfF QUW 090— of Placement:
�?,9-P?co iilw'p,
Name: k
Property Location: LuT —Ire f- LYV
Address: Ro4 Shrer Avme
Name of Mobile Home Park:
rzf applicable) (40
Phone No.
Tax Map Number:
Mobile Home Information Zoning Infonnation
Approximate Value of Home: $
Zoning Classification:
New Home: es No
es
Size of Property: ft.by ft.
Replacement Home: es No
Existing buildings:
Size of Mobile Home: ft. by ft.
Setbacks: front yard (4-,,C', f L rear yard zkicft.
Singlewide: Doublewide: Side yards 2,C &and 2--c-) ft.
Number of Rooms: (exclude baths)
Number of Bedrooms: Accessory Building(s): circle
Number of Bathrooms:
Detached garage: I car, 2 car, car
circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: , 2 car, car
Storage building: Yes No
Foundation Support: Other.
TYPE SIM&DEPTH Water Supply. well or, aly
Piers x
Runners << x Is Septic
tic Permit Required? Yes or
Slab x
Further information requested on the reverse side of this sheet W
Name of Installer or Mobile Home Dealer. t oez -
Address: >
Phone No.
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
1. Insignia serial number. %j) o C) 9 -7 (P
2. Name of manufacturer '�''���
3. Plan Approval Number:
4. Model or Component Designation:
(New Home OMY)
f C �JC 5. Date of Manufacture: -� 'L
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, and that such work is
authorized by the owner.
Signature: �owner,owners agent,architect,contractor
------......__...........................
_..._�_
Special Conditions of Permit
By
Form: 1 r/19/1999sh Code Enforcement Officer
NO.558 903
11.01 GLENS FALLS MOBILE & MODULAR 4 7454437
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"I ha4seen or observe ,or bi lieve I saw evidence of,
all objects such as hoes s,rvel ,trees,fences, etc.,
t shUwr� on this doctamen I also represent that t have
pe soa it measured th dista es set forth on the diagram."
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Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1 OWNER INFORMATION:
................... .............. ..................
Office Use
Location of installation: L dri "!�S A e a V,L .
Tax Map N0308 P I 0 File Permit No.
Fee Paid
Owner's Name: �.4 Im
�(1/}kk A)
................. .................................................................................
Address: 6,4,J5;&V6012F 41�
2. INSTALLER'S NAME PHONE NO. 73 t?dl :
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and multiply#of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdrm =
1980- 1991 x 130 gal/bdnn =
1991 —present x 110 galfbdrm = 3 3 0
Garbage Grinder Installed yes no
Spa or Hot Tub Installed yes— / no�z
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Too izra-ohv SaiLNature Ground Water Bedrock orl=ervious Material P. ater Supply
Flat ' sand at what depth at what depth (nunicipal
-RWing loam —feet feet we7T -'
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. 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). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank:
gallon(min. size 1,000 gal.) Fie,,4-T7 6AJ 0 (E�>C/-0
Tile Field: each trench ft. Total System Length:
Z>D 1 pj Seepage Pit(s): number ofL_ size of each: ft. by ft.
Size of Stone to be used: # depth or thickness feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: f Size of each:_gallons TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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 Sanitary Sewage Disposal Ordinance.
C-D
Signature of responsible person Date
,',twit •tit" �Z�tt;��t:salnii•y
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?, SlaNA►'TURE &INFORMATION I = VVN;sloj r-rr-awv►.\y„an.v...».:; ,
ULENS FALLS MOBILE & MODULAR a 7454437
N0.558 D02
A.ppucatfion for Permft Septlr Disposal Syt rt(t f��-
Town ofQueensbury 742 Bay Road OueewAury,NY 12804 (S19)161-8256 j
i- OWNEIL xNFORMAT ION:
L of �.f ;. UL , µ m_. Office USo
Location of iustaU.aCion: �
_ r
Tao Map No3°S•O� � ! fP 1 Fj,lc Pe�Onit 1�0.� 1��'___.`_✓"�
Owners Natnc: &A >sae Pe!d
Address: _ 3,-W 2T gi /l/ 4 _,�. .. ..��.... . . ._ ...a
2. INSTALLER'S NA.No (r PH6NE NO, 7
3, RESZE> sZKC.E YNFQRUATION: (circle year of dwclling,Indicae#'bedmam(s)oixd n u ciply Y#of
bedrooms with applicable gallons pier bedroom to oqual total dullyflow)
Y=Af Hnuse• No.of�ed�rgo x ComnutatiOn 2t �ota3 DSi1V FIoW 1980 or older x 150 gallbdun = An '''"L ION
1980—1991 x 130 g%Mdrm =
1991—present 3 x 110 gal/bdrm '� o
ckrb"P Grinder Tastailed Yes— no .M AY
Spd or Hot Ttib Installed yes
TOWN OF QUEENSBURY
4: PARCEL IlVFORMATION: (circles lieablo iiltormadon do Indic ate mea8iaetnerxts) I @I G ANQ,CODE
s9axa-umn Qmuw Wow klmajgj
srYnd at what depth at what depth uRicf a
laa�rt e we
r
S'tagp Slope clay — tf welh water Supply
_,_9S siopa other from any Septic-sySyam
depth: absorption it ft.
other r
Pacalntioan Tess: 1'1'o be corrtpleted by 1ice�sPd professional engistxcr or as+ehiteCr) ,
Rate' _ minute per inch
5. PROPOSED SYSTEM: Tbr mrw Action: All inQividual scwaea disposal systems mast 6c desiignad by s liccnscd
profeaStonal cbgiA,eer ar azrl►itaot(usiless Axstallnd to a Ptomaine 8aard agptored aeYbdivisian). Add 250 galleas to ebu sizr
of*-septic ttak sad leacb field fbr oath Gubage G4,dr4 Spa or Wlrirlpooa Tab.
6ycr0Txi,vco
Septic Tstale gallon(mix.Am 1,000gat)
Tile Field: each trench__ ___ Total Systeui L=Wft
size ofea�
Size�f Stone to be used' 'rp /depth or diiAna=
Bad SY&UM Size: x
.Altcmxuve Systeaa• length and/orstre
�. HOLDINO TANK SYSTEM: ('tf Tcquirtd)
Number of tauten: f Si c of OWL— -gallons t ToTAL CaPaaty: gallons
Note: Alm=Systcia and associated electrical work must be ingested by a Town approocd
clectxioaI inspcotion agency.
7, SICI'NATURE &INpORMATION FOIL RBSPONSMLE PERSON(pleasr,rrad)
)For your protectj=.pleaSe note tjW pursuant to Secuao 136-29 oflthe Code of the Town j
of Queembury,an-y petunt of 0pproval granted which is based tgPo6 ox is granted in
z elisaoc upon auY material uAarepiesantAtionid s
Crar tkilttre to make a 2$atc7 iAl fact or
circumtance lmown by or an behalf of an applicant,sball be.v `
I have road the xc clatioas een�sb t to ibis opliamaicu and 3anitary Sewage Disp° :tip abide by ssl brdizix+nac_these and aL[
requiremc �--
Signature of re*Potlslble person Date
Queensbury Building & Code Enforcement - Residential Final Inspection
cWentJ112"-
Chimney
Office No.(518)761-8256 Arrive: am/p art:Date Inspection request received: -7 `? Inspector's Initials:
yNAME: J t1 PERMIT#: , ,l.—
LOCATION: `j (f ,rDATE:TYPE OF STRUCTURE: oe , ComIVI
Y N NiA Ht./"B"Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumb Vent through roof minimum 6"
Roof Co lete/Exterior Finish Complete
Guard 30 in.or more @ stairs,decks,patios
Guard at stairwell at 34 in.or more
Guard at deck,porches 36 in.or more
Exterior Finish Complete
Interior/Exterior Railings 34 in.to 38 in.
Platform at all exterior doors
Interior Handrails stairs 2 or more risers
Enclosed Stairs Sheetrock Underside minimum ''/2"
Gypsum
Grade away from foundation 6 in.with 10 ft.
Handrail Termination at Newell Post or Wall
6 inch clearance to sill plate
Gas Valve shut-off exposed/regulator 18"above grade
Gas Furnace shut-off within 30 ft. or within line of site
Oil Furnace shut-off at entrance to furnace area
FurnaceiHot Water Heater operating
Low water shut-off boiler
Relief Valves installed/Heat Trap/Water Tern 110
Interior privac. /trim/doors/main entrance 36 in.
Bathroom I Kitchen waterti ht
Safe Pzui_/Window in stairwells safety lzin
Interior Smoke Detectors:
Every level: / Every Bedroom: v _
` Outside every bedroom area:
Inter Connected: / Battery backu
Carbon Monoxide Detector
Bathroom Fans,if no window________,__
Plumbing fixtures
Foundation insulation
Floor truss,draft sto in finished basement 1,000 sf
Emer enc a Tess below rade
Basement stairs closed rise>4 inches
Garage Floor Pitched_____________
Gara a fire roofin /'/.hour fire door/door closer
Duct work Sealed ro erl
Gas Logs in Seated or Glass Enclosure
AtticeCC—a ss 30 in.x 22 in.x 30 in.(ht.)In accessible area
Crawl S Daces 18"x 24" access, 1 s . ft.-150 s .ft.vents
Buildin No./Address visible from road
Final Electrical
Site Plan /Variance required
Final Stove Plot Plan
As Built Se Dtic S stem/Sewer De t.Ins ection Sticker
Flood Plain Certification,if re uired
Oka to issue C/C or C/Of Tem orar /Permanent
L:\PamW\Buildinq,&CodeS`\Inspection Fortns\Res.Final Insp.form 2.docLast printed 2/12/04
L INSPECTION REPORT
OBILE / MOOULAR
NA R
Town of Queensbury f�, �� r►—
Building & Code Enforcement 1
742 Bay Road
Queensbury, NY 12804 ] 1'5 ,r
(518) 761-8256 (-1 ST
'
ARRIVE: DEPART:I A�cv_INSP:
Oak-
DATE INSPECTIONREQUEST RECEIVED:
` q p
NAME: t.Ar Pe
LOCATION. l W J J�`�b�elo�6 1e
DATE: f4i. 7/ (l aS PERMIT#0
MOBILE HOME MODULAR HOME
FOOTINGS _ FOUNDATION _ BACKFU.L_ FRAMING_
N/A YES NO
1. foundation support, pier spacing
per manuf. ........................ — —
anchoring per manuf.
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
f deck, porches, steps, railing ........ — —
fiunace/hot water operating ........ _
11. garage fire proofing ..................
12. door closers ........................... —
13. plumbing fixture ...................... _ V%/, _
14, foundation insulation (if appl.)...... — —
smoke detectors — — —
final electrical .. �`L� r...
17. variance required ..................... —
18. data plate okay ....................... — ; —
19. mobile HUD seal okay ..............
Model #—:ZA kO I Pr Serial
Manufacturer N.:�- _ -
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments:e-r'�Lpers
4V"%-- T2fZ�7 C�NA
WAX
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256/jam
ARRIVE: DEPART: INSP: C
DATE INSPECTION REQUEST RECEIVED:
NAME: V2�/L U
LOCATION: \
DATE: �D I.� PERMIT 465147
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. 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 # Serial#V)c
Manufacturer h-SA-R-j
Date of Manufacturer 0�-
OKAYY TO ISSUE C/O YES NO
Comments: �� Lf c ��t i
v
Septic Inspection Report
Office No.(518)761-8256 Date Inspection request received: '
Queensbury Building&Code Enforcement Arrive: am/p epart: 3 am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: )M
NAME: )11(,� PERMIT NO.: � 51
LOCATION: �� =� "�
RECHECK: INSPECT ON:
_ `
Comments and/or diagram
Soil �erMpnicipV/
ay
r.
T Well Water A-TG4A-j 1 DA-)
Waterlines ararion istance $.
Well separation distance ft. �I�.
Other wells: ft. ''�.Dpw n-, Co P 7—
Absorption Field: Total length ft.
Length of each trench ft. �
-Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: .A
Stone Size-
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit L
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 Plan Y N
-Engineer Report and As-Built Y N
Location of Syste on Property:
Front �ar Left Side Right Side
Middle ront Middle Rear
System Us4Stas:
pproved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 1/6/05
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742 BAY ROAD )• /ggoo
QUEENSBURY NY 12804
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ANCHORING OF MOBILE HOME
/ FRAME IS REQUIRED PER
MANUFACTURERS SPECIFICATIONS
I
TOWN OF QUEENSBURY BUILDING DEPARTMENT c'u?6 LDING & P
Based on our limited examination
BY
comppliance with our comments shah 7- i11EVN�C?
Fill Pnot be construed as indicating the ,
t ► � plans and specifications are in full
compliance with the Building Codes
cf N�iw York State.
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