93-733 H
BUILDING PERMIT
TOWN OF QUEENSBURY No 93-733
WARREN COUNTY, NEW YORK
00
PERMISSION is hereby granted to HARRY CROSS JR. Ln
Lot 24 Mountain View Trailer Park I
OWNER of property located at 111 Aviation Road Street, Road or Ave. k-0
in the Town of Queensbury,To Construct or place a Singlewide mobile Home
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. n
;d
O
1. OWNER'S Address is
Ivan Barsuhoff
PO Box 4502 x
Oueensbury NY 12804 n
2. CONTRACTOR or BUI LDER'S Name
C4
�S
3. CONTRACTOR or BUILDER'S Address
r
4. ARCHITECT'S Name O
rt
N
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5. ARCHITECT'S Address
N
C
N•
6. TYPE of Construction—(Please indicate by X) ri
N.
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications ¢
14 ' x66 ' Singlewide Single Family Mobile Home as per
No. plot plan, specifimtions and application.
8. Proposed Use
Singlewide Single Family Mobile Home
N-�
ID
29 . 00 December 8 94 x
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19 e
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the �1 5
town of Queensbury before the expiration date.) (D 11-
F-'
8th D cember 93
Dated at the Town of Queensbury this Da of 19 co
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SIGNED BY for the Town of Queensbury F
Buildin and Zoning or fD
(D
744--e-
011,Lalegl� �, Z 14 0 1�i
TOWN OF QUEENSB URYY
Xo,yap av�
wett-V03bAlyt �451 _
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F PAID: $ �({/
�12345
PERMIT NO. Q3-13 �1
APPLICATION FOR PERMIT
MOBILE HOME OR MODULAR DEC 1993
iv
A BUILDING PERMIT MUST BE OBTAINED BEFORE PLACEMENT OF MOBIL IOME��wn fed w
NO INSPECTIONS WILL BE MADE UNTIL A VALID BUILDING PERMIT HAS BE'E1k4ISSl4u®ansbury
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ids. Dept Zvi
The owner of this property is: 11„ ,� �� �r.�? e c�'LZOZ61`$�'��
P.O. Address: P0, ySoz go 1( Phone Number71-17aSG�
Property Location (l/ Tax Map No.
/� 3'q Z
NAME OF APPLICANT: G Ct e�
Address of Applicant: u;,
All applicants spaces on this application MUST be completed a the
signature of the applicant MUST appear on the reverse side of this application.
PERSON RESPONSIBLE FOR SUPERVISION F WORK AS REGARDS BUILDING CODES:
147
MOBILE HOME INFORMATION APPROXIMATE VALUE OF HOME: $ 3GGc�
New Home Yes No ZONING INFORMATION:
Replacement Home Yes No Size of Property: O ft x `'7 $ ft
Size of mobile home i y ftx G 6 ft Existing Buildings:
Singlewide �' Doublewide
Proposed building-distance from property line:
No. of rooms (exclude baths) S Front Yard ft Rear Yard ft.
No. bedrooms 3 Side Yards ft and ft.
No. of bathrooms 2 Occupancy Information: .
Primary dwelling: es No
Fireplace Woodstove Accessory Building(s) :
Detached garage (one car /two car car)
Foundation style and size:. —_Attached- garage (one car—/two car car)
Piers-No. of _Size ft x _ft Storage building
—Other
Depth below grade ft . * * * * * * *
Foundation-Footing size " x Proposed date of placement:
Wall material
Wall thickness Height Water Supply: Well Municipal
—
Total depth below grade ft. Septic permit required? A d
Grade to home floor. level ft.
FURTHER INFORMATION REQUESTED ON THE REVERSE SIDE OF THIS SHEET
NAME OF INSTALLER/MOBILE HOME DEALER: -
ADDRESS/PHONE NUMBER
;STATE OF NEW YORK DIVISION OF HOUSING AND COMMUNITY RENEWAL
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
1. I'nsi.gnia`. erial number 07-
' 2..* .,Nam hle of nufacturer
�, .... ;
31. Plan Approval Number
Model or Component Designation eZ, lYG C-
5. Date of Manufacture A?-K
All the above information is to be found "on a plate or sticker which
should be affixed to the Mobile Home. Complete above with that information.
Town of Queensbury State of New York
County of Warren
AFFIDAVIT
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 � rLts�J Q
�� owner' s agent, architect,
contractor
SPECIAL CONDITIONS OF PERMIT:
By
Code Enforcement Officer
PD ,
3 �
N DEC P93
�! N Receive
Town of 7 y
Queens bury
Bldg.Dept. Zvi
_,�.. LZOZ/6La�
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APPR VED
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Appl6 tio�
DEC 810
A�v�-- -
—�—Zani '�ldtnin
TOWN OF QUEENSBURY
' TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
(518) 761-8256
ARRIVE: DEPART: INSP:
FINAL INSPECTION REPORT — RESIDE Iel
DATE INSPECTION REQUEST REECEIVEED: '
NAME o y w B1 Cp1c,/1"- TI R-
LOCATION
DATE
TYPE OF STRUCTURE 1 00t
FOOTINGS_ FOUNDATION BACKFILL FRAMING _
ROUGH PLUMBING SEPTIC _ INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT/B VENT/HEIGHT
PLUMBING VENT
ROOFING
EXTERIOR FINISH
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES
FURNACE HOT WATER OPERATING
INTERIOR TRIM PRIVACY DOORS
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS 'SWEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE RAILINGS
SMOKE DETECTORS
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATIO
GARAGE FIRE PROOFI G
DOOR CLOSERS 2
FINAL ELECTRICAL
SITE PLAN/VARIANCE REQ.
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C C
A/D PEPS 7 NNI, BEA0DCTVr-- GP
TOWN OF QUEENSBURY
BUILDI'IG & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
(518)745-14447
:...:i1VE DEPART: �-t� INSP•
FINAL INSPECTION REPORT - RESIDE T AL
DATE INSPECTIOON REQUES/T�RnECEIVED:
NAME �"�A I+l l �FleR
LOCATION !` e V
DATE `� l p-q �(� PERMIT A
TYPE OF STRUCTURE ��
FOOTINGS_ FOUNDATION _ BACKFILL _ FRAMING _
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT B VENT HEIGHT
PLUMBING VENT
ROOFING
EXTERIOR FINISH
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES
FURNACE HOT WATER OPERATIING
INTERIOR TRIM PRIVACY DOO S
FINISH FLOORS:
BATH KITCHEN WATERTIGH
OTHER FLOORS SWEEP LE
OTHER FLOORS CA ETED
JJr
STAIR CLEARANG RAILINGS
S OKE DETECTORS
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL
SITE PLAN VARIANCE REQ. i
FINAL SURVEY PLOT PLAN
�OK TO ISSUE C/O OR C/C
C--CFT- Ni� ,= L,)j
c1�c� o� N�-,60A,
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
(518)745-4447
:.:. i'v c.: DEPART: �t INSP: -
FINAL INSPECTION REPORT - RESID TI
DATE INSPECTION REQUEST RECEIVED:
NAME
LOCATION
DATE 41C)( PERMIT A
TYPE OF STRUCTURE VApG%r_ ,
FOOTINGS FOUNDATION BACKFILL _ FRAMING
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N A YES NO
CHIMNEY HEIGHT B VENT HEIGHT
PLUMBING VENT
ROOFING
EXTERIOR FINISH
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES
FURNACE HOT WATER OPELTING i
4
INTERIOR TRIM/PRIVACYfDOORS
FINISH FLOORS:
G I
BATH KITCHEN WATERTIG T
OTHER FLOORS SWEEPABLE Ir
OTHER FLOORS CARPETED
STAIR CLEARANCErRAILINGS
SMOKE DETECTORS
BATHROOM(FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
INAL ELECTRICAL
SITE PLAN VARIANCE RE .
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C C
J
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
(518)745-4447
:..,:iVc.: � DEPART: INSP: i
FINAL INSPECTION REPORT — RESIDE L
DATE INSPECTION REQUEST RECEIVED:
NAME H A R fJ C LA!�)
LOCATION ,1MILE�
DATE q / PERMIT A
TYPE OF RUCTURE
FOOTINGS_ FOUNDATION BACKFILL _ FRAMING _
ROUGH PLUMBING SEPTIC INSULATION _
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT B VENT HEIGHT
PLUMBING VENT
ROOFING
EXTERIOR FINISH e1
DECK/PORCH/STEPS/RAILINGS i
RELIEF VALVES
FURNACE HOT WATER OPERATING 5i
INTERIOR TRIM PRIVACY DOORS
FINISH FLOORS:
BATH KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS—GA PETED
STAIR--CLEARANCE/RAILINGS
SMOKE DETECTORS
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL
SITE PLAN VARIANCE RE .
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C C
SEEK .
J
T047N OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
(518)745-4447
DEPART: INSP: '
FINAL INSPECTION REPORT — RESIDEN A
DATE INSPECTION REQUEST RECEIVED:
NAME "Ace CCZO',,,
LOCATION Z �� �\i1 l lOt.� ��
DATE PERMIT A ,�a
TYPE OF STRUCTU �%)��� 'j I—y(
FOOTINGS FOUNDATION BACKFILL _ FRAMING
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT B VENT HEIGHT
PLUMBING VENT
ROOFING
EXTERIOR FINISH I
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES
FURNACE HOT WATER OPERATING
INTERIOR TRIM PRIVACY DOO S
FINISH FLOORS:
BATH KITCHEN WATERTIG T
OTHER FLOORS SWEEPAB E
OTHER FLOORS CARPET
STAIR CLEARANCE RAILI GS
SMOKE DETECTORS
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
NAL ELECTRIC
SITE PLAN/VARIANCE RE .
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C C
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
'r 742 BAY ROAD
QUEENSBURY NY 12804
(518)745-4447
DEPART: INS 4
FINAL INSPECTION REPORT - RESID NTI
DATE INSPECTION REQUEST RECEIVED:
NAME �.
LOCATION L Z 1
DATE I 9� PERMIT
TYPE OF STRUCTURE -
FOOTINGS_ FOUNDATION BACKFILL FRAMING _
ROUGH PLUMBING 1 SEPTIC INSULATION
FINAL ELECTRICAli,_ WOOD TOVE OR FIREPLACE
INIA-1 YES I NO
CHIMNEY HEIGHT B `1ENT HEIG T
f
PLUMBING VENT \ /
ROOFING V /
EXTERIOR FINISH
DECK PORCH STEPS RAILI GS
RELIEF VALVES
FURNACE HOT WATER OPERATI
INTERIOR TRIM PRIVACY DOOR'
FINISH FLOORS:
BATH KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED / I
rSTAIR CLEARANCE RAILINGS
S OKE DETECTORS ` IL
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL
SITE PLAN VARIANCE RE .
FINAL SURVEY PLOT PLAN i
OK TO ISSUE C/O OR C C
�� ��4c�\3
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION /f
DATE PERMIT #
TYPE OF STRUCTURE -117d,c-66,
RECHECK APPROVED
N/A IYES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLLOWING
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE ;
PLUMBING UNDER SLAB
FRAMING: t F7
JACK STUDS/HEADERS A
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BE
A
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALVS INTERIOR R-
FOUNDATION W LS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
'
J s
of � � �� ,
ARRIVE
DEPART �j -
INSPEC OR
THE NEW YORK BOARD OF FIRE UNDERWRITERS " AiLA; .1
�,t 9C.1 fit)"...l. BUREAU OF ELECTRICITY
F 111 WASHINGTON AVENUE,SUITE 704,ALBANY, NY 12210
,PLUG JST 3,'� d96 Application No.on file�1,43;c53596 �96 H t1'�43TY
Date ?nu�L THIS CERTIFIES THAT � 3-
only the electrical equipment as described below and introduced by the applicant named on the above application in the premises of
I-IF"./Ms. !-E.AMEY MCGIS J}:. :, :all I'sE'.LI3'TION RD. � QUEBASM011 ..,. -N.Y,in the following location; ❑ Basement ❑ 1st Ft. ❑ 2nd Ft. Section Block Lot
AUGUST .::0,.1.96
was examined on and found to be In compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS RECEPTACLES SWITCHES INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECTT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT.' K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS AMT. WATTS
NO.OF FEET
_ SERVICE-DISCONNECT._ NO.OF _. .-5---- --._� ..._.-z__R.-- Y._ ____._ 1__ C. _..E ,.... -._
AMT. AMP. TYPE METER 1 X 2WT1 Ar 3W 3 AI 3W 3.8IW NO•OF CC COND. A.W.G. NO.OF HI-LEG A.W.G. NO. NEUTRALS A.W.G.
EQUD. PER N OF CC.COND.. OF HI-LEG OF NEUTRAL
OTHER pA�YtPP gA,,RppATU14S: Co PIGTAIL
q r7 iy q y Tt{{p T 07l
Fow
�YUEIEIRSMlll'Y, BUY, 128134 BRANCH MANAGER
t1{ Per
This certificoe must not be altered in any manner;return.to the office of the Board if incorrect. Inspectors may be identified by their credentials.
0 ® 0 0
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