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2002-429 TOWN OF QUEENSB. URY yq 4 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761.8256 C ��RTIFICATE Of OCCUPANCY Permit Number:' ?20020429 .:.Date Issued: Tuesday,July 23,2002 { This is to certify that work requested to be done as shown by Permit Number P20020420 has been completed. Tax Map Number: 523400-309=009-000f-0119-000-0000 Location: ILLINOIS Ave . Owner: GEORGE&SANDRA CLARK SR Applicant: GEORGE&SANDRA CLARK SR This structure may be occupied as a: By Order of Town Board Mobile Home Out of Park TOWN OF,QUEENSBURY Director of Building&Code Enforcement. TOWN-OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020429 Application Number: ,A,20020429 Tax Map No: 523400-309-009-0001-019-000-0000 Permission is hereby granted to: GEORGE& SANDRA CLARK SR For property located at: ILLINOIS Ave 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. Tyke of Construction . Value Owner Address: GEORGE& SANDRA CLARK SR 42 ILLINOIS Ave Mobile Home Out of Park 35j000.00 Total Value 35,000.00 QUEENSBURY,NY 12804 Contractor or Builder's Name/Address ` Electrical Inspection Agency FRFDF,RTC?K SMITH 23 VF,RMONT Ave 01 TF,F,NSBI TRY."NY 12804 Plans&Specifications 2002-429 Address per Dave Hatin: 34 Central Avenue 1232 sq ft MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS with new septic system $78.00 PERMIT FEE PAID-THIS PERMIT<EXPIRES: Sunday,June 01;2003 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at th : n of Q nsbury; aturday,June 01,2002 SIGNED B for the Town of Queensbury. Director of Buiulzring& de Enforcement T�y Application for Permit— Mobile Home . Town of Queensbury, 742 Bay Road Queenshury, NY 12804 (518) 61-8256 A building permit must be obtained before placement of mobile home on parcel., No inspections will be made until a valid building permit has been issued. Applicant Information € " Office Use Name: °, C",UPAQ� File Permit No.�_ — `( 06 -Address:4;�, `Zu-mot 5 �WE_: Fee Paid Reviewed By; j ..............-........................... ...... - -- .. Phone No. Z ASD 2 EcENED PrOj7erty Owner Information Parcel Information � `Place' Name: - f l�, � �PU� tbl ernt: �� � � �tNC���®C}E (� ....-- r e Location• Address: 40; J:7W N01 S Name of Mobile Home Park: (if applicable), 7 Phone No. Tax Map Number: / Mobile Home Information Zoning Information Approximate Value&Home:$ Zoning Classification: ,c New Home: Yes No 0,`3T �„ Size of Property: Replacement Home: Yes No Existing buildings: Size of Mobile Home: ft.: by . ft. Setbacks: front yard . _ft.; rear yard fL Singlewide: Doublewide: Side yards ft.and ft. Number of Rooms: (exclude 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 municipal Piers x Runners x is Septic Permit Required? Yes or No Slab x Further information requested on the reverse side of this sheet *' Name of Installer or Mobile Home Dealer: 7 Address: Phone No. 51 '~S" ' 00 t 5 Complete information below found on 'a"plate"or"sticker"which is affixed to the mobile home.. 1. -Insignia serial number. 2. Name of manufacturer. 3. Plan Approval Number: Node' _ mpdnent Designation: 5. Date of Manufacture: e7 �X?1 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,owner's agent,architect,contractor Special Conditions of Pennit By: ram:.1vr9rt99ssh Code Enforcement Officer Application forTermit—Septic Disposal System . Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761=8256 k I C1WI�t�ER INFOI2MtA0IOl • ..........................................._......................_................. ..._ .1....:........_.._....__..., Location of installation: `) IY` Office Use File Permit No. (% Tax Map No. I I i Fee Paid } Owner's Name: G 60FAfi F , ` 1� ............ .....-.........._................. -.....,.. ..........€ Address: J7Yf /Y% j a G 2. INSTALLER'S NAME t'�> PHONE NO. 3. RESIDENCE INFORMATION; (circcle year of dwelling,indicate 0 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/bdrm = 1991 —present x ' 110 gal/bdrm = 50 Garbage Grinder Installed yes I no Spa or Whirlpool Installed yes_ 1 no 4. PARCEL.INFORMATION: (circle applicable information&indicate measurements) rah Soil Nature Ground Water Bedrock or In ervious Material D Water Suppl sand at what depth -at what depth m nicipal Rolling oam feet feet well Steep slope clay if well; water supply- _4!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 Jcensed professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to t c size of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: " gallon(min. size 1,000 gal.) Tile Field: each trench ft. Total System Length: ft. i Seepage Pit(s): number of size ofeach: ft. by ft. i Size of Stone to be used: # / depth or thickness feet i Bed System Size: x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / 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.- Ems" • igna# re of responsible person e 1PINAlL 11NB REPORT - -Fio%_n cif- CQueensbury Buildirt+g 8L (::odEi Enfcarcani4qnt ?42 Bey Rc o�ac# C)u+wgnabur , NY 12804 (518) ;?61-8256 I.;e f- .�.Ixlalv�: -'k)._= AM DATE REQXJES-r RECEIVE DATE: 76 ,3 PEIZMI'r ##Ar M�SIL� EI81�lIE MODLTLI�:R I$-IO11�E FOt�TINCxS FC3i.7i�DA'I'IC?i`3 E3ACKFI7 i _ F]EtAMING T/A XES NC1 1_ f6xuxciatic>n sixpp�ort,- pier spa ing pern-ia hill ... : ......... .. ..... 2. anchoring per manuf. ........ ._._. 3_ water line shut off ------ - -- ---- --- 4_ sewer Iiue support S_ li{eatirig -cross©ver (dblewids) o grci _ 6_ dryer vented outsides --.-------- -- - 7- slcirtirng ventilated ------------------ 8_ hot water relief valv g ou e piping 9_ deck, perches, steps, railing --_._. . If)_ furnacelhot water operating -------- 11_ garage fire proofing - --------- --- - ---- 12_ dcaor closers ------------------------ --- 13_ piustxbing fixture -------------- --__.-__ 14. foundation. insulatien (if appl-)...... 15- s3molce detectors_ ....................... 10- final electrical ----------------------- 17. va.ria rice- requir+pd --------------------- 18. data plate okay .. ........... ........... i 19- mobile H iJD seal -c3kay -------------- i Model # - Serial # R/lanufacturer - Of -Bate of Manufacturer - � C7►KAY TO ISSUE-C/C3 YES = NC3 Mullclino 8L +Cc"iq EFnfcorc*amE nt 742 Bay Flaacl Clue nsbury, NY 12804 (SI 8) 761-8256 -r RECEDE JE::�A-771F- rCEQT-J]F-S PERMIT'-DATE: 7 mw- IFINMNSIM I- FC>jMMdatjC:)j-j StAPP400rt, pier spacing perTKIPLI-Allf. ................ . ...... 2. a-lllv-hc>rixlg per ixtalallf- --------- --- - -- 3. water line shut- off ------- ------------ - 4- sewer Brie support (ED 4 feet ....... 5- heating crossover (clblo-vvi4zlg--) off6- dryer vend CPlUtSi4LL-- --------------------- -------------- ------ 1-100/r 8- hothotwaterwater relief pippipingC>11tsidf- a- 9- clg--ck, pc>t-r--Uf--s, steps, railing -------- fxxrxm4--o/hc3,t wgLtt--r 113pf--Iramtilag -------- g,%x-ELSt-- fijr*-- pr-cm::PfbmS -------- -- -------- 12- dbcm:xr- closers --------------------------- 13- plumbing fixture. ...... ................ 14.. finmmciaticma ixlsAllAxti<>xx (if nppl-)------ 141C. sTxlc>k*-- df--tp(--tc>rs ---------------- ------- 16. final ole�tvicztl ------- ----------------- 17. Nrariiumoc-- required. --------------------- IS. data Platt-- CikkLy ----------------------- 19. rmuolooilt-- 141JID seal C),Icay .. ............ McNille-I # t7- sf--rizu iv Y-A Manufacturer Uoatoa- of Q � 4J 0 01 G1 ,r �u 4J ,.' 4J z 2 w z W 4J41 4J � 41C 11 F- � C � 0 U W 0 E ,1 v) �r 0 0 U dJ Q 0. � , C nW � r 4 a. ro +j + C L \ 1» 0 � 0'q ( �, � 0 ro /y0 0E� �y C�7 .� �0A In r-� 4�-1W, M 4J 0 0 rat ! r w 00 S. 0 T' X r C O P CL ''.! W i 4d W U! a� I a a 4J QJ VVV Z 4- 0 41�. rS 4 C 0 W -C U II U. 0 to I 0. v i(~ a 0 0 r- H U C N , 9 r'- 4 0 0 "4- f 1�. Fm �� 0J {1) t1 .0� LL 0 0 C (A C � Q (U il � 4-' 0 L 44 �w 0 � ro 41 �. a1�' u� day l)� yw{(L1» ` C Ma9 N cr +a 4. U > 4' T H 'r" H l Y I C lrr i. Y aR C 1V } IMd Ali 1� W 0't 0 4•• cn Q, N 0 X S% 0 0 0 0 a S. M 0 NaU- �"' a04-W 0 M -Po CAM 4-) 04� F 0 i Ix -P .0 0 Z '0.'0 S. 0 11% U 4J W 4) 0 0 W � W001� 41CLNCNU).Y0C4tCCio4- I S» CV � ' 'la0 E U +j I� �n4- C� 0Ca. NWN00L11CW (D ZZa, Cto It- 0 * � JCL �P (0 0 it 0 tU �r � M 0 4)-t-W aw 4J b r- (S-r a � 00 0) 0 0 U S. at O 3M I. 0 �� z -j m 0: -jpin(A0V) a, mF- aO JLLU.Vnu LL2: U V1 ao lV E MAY 2 2002 TOWN OF QUEENSSURY r ti tl: Ii I: r, W1H WANDRY DINING BEDROOM DEN UTILITY KITCHEN ROOM No,2 E u wz aa, 0 Q OPTION DEN I O to -- N STAHWEtt ` CATHEDRAL TRRUdIUT ---- A MASTER BEDROOM i LIVING ROOM BEDROOM 304' 13'•S° No,3 BEDROOM 12' No,3 12, I 8600CTI*3BEDROOM•1314BATHS•CATHEDRAL THRU•OUT(1,144 SQYT,) OPTION STAIRWELL IV (D Zr zt (D (D ;44 0 U)j P* H 0i ryV CO (D 0 4h COPY ANCHORING of MOBILE HOME rn �/k FRAME is REQUIRED PER MANUFACTURERS SPECIFICATIONS 0 Not N001 � r i AV N OF QUI: )9 RY TOWN OF QUEENRURY BUILDING DEPARTMENT BUILDING& used on our limited examination, REVIEWED BYompliance A our comft 0all 6` �,, not be contued as�i*h ' plans and specifications 8re in U DATE compliance with the code, � .,r. ..MM+N�f.1A. 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