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2002-753 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 AT OF OCC.UPANCY CEITIFIC Permit Number: P20020753 Date Issued: Wednesday, October 30,2002 This-is to certify that work requested to be done as shown by Permiyt Number P20020753 has been completed, Tax Map Number: 523400-308-006-00017061-00,0-0000 Location: PETRIE IJn Owner: SAMUEL&VIOLA WAHNON .Applicant: JACK AND ROSE ANN HARVEY This structure may be occupied as a: Mobile Hole 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: P20020753 Application Number: A20020753 Tax Map No: 523400-308-006-0001-06 1-000-0000 Permission is hereby granted to: JACK AND ROSE ANN HARVEY 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. I Type I Value of Construction Owner Address: SAMUEL&VIOLA WAHNON Mobile Home In Park 39 SARATOGA ROAD Total Value GANSEVOORT,NY 12831 Contractor or Builder's Name Address Electrical Inspection Agency Plans&Specifications 2002-753 Jack and Rose Ann Harvey Lot 25., Petrie Lane, Queensbury Village Mobile Home Park Installation of 1,456 sq ft double'wide mobile home per plot plan and specifications. $62.36 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,September 23,2003 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Tow A<Queen h ry; nday,September 23,2002 SIGNED BY A 7d for the Town of Queensbury. Nenforcement 0.M�Director Of Building CodeL Application for Permit— Mobile Home RECEF"'/ED Town of Queensbury, 742 Bay Road, Queensbury, NY 12804 (518) 7"'96 0.52002 A building permit must be obtained before placement of mobile home on parcel. No WspWlQfs%Il'bd)ffih'd6 until a valid building permit has been issued. FULDNIGN. CODE Applicant Information Off Use Name: File Permit No. 2M Y3'!� Address: c tw-A�V�� Fee Pai#dJ Reviewed By: ................ Phone No. v7q n q-1 Property Owner Information Parcel Information Proposed Date of Placement: to Name: zl Property Location: 2 -I 6U-e Address: Road.,street,Avenue Name of Mobile Home Park: ffapplicable) Phone No. I Tax Map Number: —to Mobile Home Information Zoning Information Approximate Value of Home:$ ' 00 - Zoning Classification: New Home: Yes NO, Site of Property: ft.by XD-ft. Replacement Home: Yes I No Existing buildings: Size of Mobile Home: ft. by S', —ft. Setbacks: front yard ft; rear yard ft. Singlewide: Doublewide: Side yards ft.and 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 AJ)+ Attached garage: I car; 2 car, car Storage building: Yes No Foundation Support: Other: TYPE SIZE&DEPTH Water Supply- well or municipal Piers x mifidip Runners x Slab x Is Septic Permit Required? Yes or No Further information requested,-on the reverse side of this sheet W Name of Installer or Mobile Home Dealer: Address: �� f ' (2n I Phone No. '�p Complete information below found on a"plate"or"sticker"which is affixed to the mobile home. I. Insignia serial number. 2. Name of manufacturer. 3. Plan Approval Number: ?eq d 4. Model or Component Designation: (New.Lorne ONLY) 5. Date of Manufacture: AFFIDAVIT Town of Queenftry State of New York County of Wamn 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 an 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:. 6.9-2,1 1, /,J� owner,o, er's agent,arc ' contractor Special Conditions of Permit By- Form: 11119t1994sh Code Enforcement Officer 4(q A t Project Name: _4 , I BP# Address: =@59!d9# MA-P— )1&ding Permit Submission Sbp,lefianily duvUbg u -T ar of dy dvding Checklist All items below must be checked either yes,no or not applicable prior to submission of any building permit to the Town of Queensbury Building Department. If any of the below items are lacking,the permit will not be accepted until such time as the application is deemed complete for submission. 1. Building Permit Application Completed ... ... ... ... ... ... ... ... ... ......... . ar s E]no E] n/a 2. Energy Form or CheckMate Energy Code Compliance Forms Complete.. [:]yes El no VJ n/a V—� 3. Energy Code Inspector's Report from Checld&te Program... ... ... ........ F]yes n no "�n/a 4. Septic application completely filled out(if applicable)...... ... ... ... ...... ... EJ yes EJ no %n/a 5. Solid Fuel Burning or Gas Appliance Form... ... ... ... ...... ... ... ...... ... ... .nyes r1no Kn/a 6. Electrical Inspection Form... ... ...... ...... ...... ... ...... ... ... ... ... ......... .. Oyes JAno Mn/. 7. Two(2) complete sets of structural drawings..... ... ... ... ... .... ... ......... ... .Ayes [:]no [:]n/a a) floor plan,b) foundation plan;c) cross sections:d) elevations; e)window and door schedule 8. Two(2) site plans showing location of the structure to be built. ... ...... ... es E]no E]n/a location of well or water lines,location of septic system or sewer line. KY 9. Setbacks from property Les to new structure ,.. ... ... ...... ... ... ........... Flyes F]no Kn/a 10. Setbacks to neighboring wells and septic systems,including onsite wen... . nyes nno a and septic systems (if applicable) 11. DrivewayPermit... ... ... ...... ... ... ... ... ... ... ... ... ......... ... ... ... ... ...... . Flyes f-Ino �n/a v'a Date: Staff Initial: L.\Sueliemingway\BuUding.Pern it.FOFIvE\Generic ChecMist.doc IF=lr4lhMAOC%LL_ Jr%MjMF=M4=-jrlCM" MMMB=CMJFM-lr ice/ 4=IE3§L-m N%nCMCMILJL-AM&Fm- -row,n- of- C3ue nsbury Oui"inig SL t:cxlc3 FEnfcwceime3nt 742 E3c,-ty Flomcf C)ueonsbury, We 1 .2804 (518) 761-SM56 DATE INSPECTION IJEST RECEIVED: perunrIA-A.3a. . ........ ........ . ..... pear u .-.;........ .... 3- vv"Wr Iia- sluxt c> . ................. 4- sewer licesm ------- lleatixlg ca-r-<3rso CAF grd- f_ dryer XJLtSjdV--- - ----- ---- ----- ----- -7- skirting -.-4--jatilate4d - - -------- 8- hot -vv.-zttt--x- relief valve piping outside - deck, pcwc--hc-,s, steps, Jr.-tilizig - ------- 10- ftu-rmc4c--/hc3t Vvatt--r lop4--riLti-no - Il. garage fire ----- --- -- --- ----- c:R>st-,rs --- - ---------------- ---- --- 13. pltxnaVcPixx,&x -Xtxlrc. .. .. . . .. . .. ....... . .... 14. fomirLdaticma irLsulaticm (if *tppl.)------ 1:5- SX3MCACe-- Clt--U-cU>JrS ------------------- ---- 116- final electrical ----------------- -- ----- 17- variance x-e,qxzirc;4d --------------------- is- data PIELt*-- c3o1uay ---------- - ------------ ISO- --------- ----- Town ofow Building 742 May Road - _ Queenslbury, NY 12804 ARRIVE_ DEPART_ DATE INSPEC'I'IO REQL7EST RECEIVED= I_.ocATION: ��� T �=�f21 � ��•� - I ►A'f7F: `�- G� ---"' PBR MIT 'Gam .. •-1'ti FCX7TIN�S FC]�C.TNDATION I.'kA.CK:�ILL FRAArIIhTCx. ItTlA YES No 1 support, pier spacing y�f pe,r r =+Tuf+ ............ .. 2_ anchoring per irlanuf_ ---- - -- --- ----- 3_ water Brie shut off-f - ------------------ - 4. sewer line support (W 4 feet - - 5. laeatin,g crossover a[d.blewi�de} .off-grd_ 6_ dryer vented outside __�------------- - 7_ skirting veritil.ated --- --------• ----- --- S. hot water relief valve piping outside 9. deck, porches, steps, railing --- ----- f» na lU_ rrcelhot water oe prating- ---.-.-_ 11_ garage fire proofing -_.. _•-- ------•--- 12+ door cldsers ... ............. .... .... ... 13- plumbing f"ixtui-e - ---------------- --- -- 14- foundatioza insulation (if_appl_)_.... . I s- smoke detectors ILO- final 17. variance required -- -- ------ ---------- Is- data plate okay _ .__•------ - - - --------- i I9_ mobile HUD seat okay -------------- :Model # ` � ' '- Serial #of—' LAHO IVlariufacturer �-�5'7�l� K.bt3� !�-� - Date of Ivlazikufacturer ��! ..�� �'"' �, C31<44-Y TO ISSUE -YES NU f �= kw:I WOCK 7 ZffY _ RECEWED Glens Falls Mobile Modular Homes, Inc. 3F Saratoga Road S E I' 0 5 2 -32 Gpr�sevoo�t, 12831. , TOWN OF QUEEN' (518}79�-2801 O"hvrves.com (Wx).798-2603 �__-- _. E . .t. - - d'L��S • {ty� Vye wA► r A4rff Je nanaoot z • ���r��l+r ��jii� �r►tNC tt ax nxnreooAr a _ t • r v � 60 tr� JIMPRox 1,347 sN.17. QUEENS i� T V1lP Cc Y _ . BUILDING &.CO D r REVIEWED BY i DATE _._. fvApy FILE TQY ii C'=%CNZCURY CiUli.GtNG DEPARTMENT Pa,eci on our limited examination, c',,)rnpliance v&our comments shall not be construed as indicaft the plans and specifications are in full compliance with the code. ii -;rl o c o uu I G' 407.36 W APPROX ""tee► SEPTIC W APPROX AREA S 83'19'05" E AREA(n TIC 1.$2' vt bo = Q 842.06 "'^ 111 r 3". house UT1� 1 "'bgWTl� 125.00' � 1_tN�iV: N 82'55'30" W ------- I 7T W APPROX (n M 20.16'I GARAGF., Tic HOUSE LANDS OF I TYLER CONVERSE I LOT 1 168,965 sq.H.. © 3.88 acresCO x IU a o x SHED j 43 LANDS OF r 12 BARBARA CHERRY W 0 x OIRIIX 0 I HOUSE W t� 1A O BREAK f AWAY 00 GATE EMERGENCY ACCESS w M •27 L.+IR :3 EASEMENT FOR LOT 2 6 i7 N83'21'27"W qh 125,00, N 83'21'27" W N.Y. STATE LIC. NO. 35617 MAP # SPkC AREA W 0.1� AREA APPRO%. "4 A 00 83'19'0'5 rr AV', 14 aT i �l 55' ,/ 1299.9,2• I II j BUP1 o b� .. . o. m j 001. bn5 N t�.$Z I I 1 /1� I _ Hous AC` C_.-.--ESS..ROAD 'l -� I I b � PARKIN 11'f AREA �� _1� � � c_sr�cEs 16.35 ACRES % t l `�S4o \ wool-6 9 tuNQ� I i tt �Q V C7 �-p l� R 1 I--- � _ 1T .kl n IV A 17 Gh I HOM 5 N n E e� •11Df I 5 al SHED I w t ) &z. � rio I I o n 5 it OTP ry I z a 10 • TO BE R 0 55' # z � 6 L 1 e a+rAEo -- _ PP X. AR R LA 27' W 25+75.,1— B' I _ '�4 RE 55T 4-GRA VE p ( I — FoR�D p K,ROAO _ fi _ r�— ;og B rrs c��m