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2002-869 P TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518 761-8201 Community Development-Building&Codes (518)761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20020869 Date Issued: Friday, September 05,2003 This is to certify that work requested to be done as shown by Permit Number P20020869 has been completed, Tax Map Number: 523400-308-012-0001-023-000-0000 Location: 19 EAST Dr Owner: JEFFREY&REBA JOHNSON Applicant: JEFFREY AND REBA JOHNSON This structure may be occupied as a: By Order of Town Board Mobile Home In Park TOWN OF QUEENSBIJRY Septic Alteration Residential Director of Building&Code nforce ent TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020869 Application Number: A20020869 Tax Map No: 523400-308-012-0001-023-000-0000 Permission is hereby granted to: JEFFREY AND REBA JOHNSON For property located at: EAST Dr 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: JEFFREY&REBA JOHNSON Mobile Home In Park 20,000.00 22 PINE CONE Dr Septic Alteration Residential QUEENSBURY,NY 12804-0000 Total Value 20,000.00 Contractor or Builder's Name/Address Electrical Inspection Agency MAILLE. W.W. EXCAVATING Plans&Specifications 2002-869 House No. 19 East Drive, Jeffrey and Reba Johnson Tax Map Numbers: 308.12-1-21; 308.12-1-22; and 308.12-1-23 to be merged. Tax Map No. 308.12-1-23 will be the parcel for placement of a used mobile home (1,064 sq. ft)with new septic system as per plot plan and specifications. Town Board approval is needed since mobile home will be outside of a mobile home park. Town Board meeting: November 18, 2002. Current Zoning: Ll-lA $63.84 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,December 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 pl't'th�ewn o ue nsbnday,December 23,2002 SIGNED B for the Town of Queensbury. Director of Building&Code Enforcement 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: tf gCls o LAN 7 No—zo Tax Map No.-46�1 File Permit OCT .1- 1 2002 Fee Paid Owner's Name: J.)-)I Jnm.'21,19.5 U Address: AAty 2. INSTALLER'S NAME a&Vo-7t6ja PHONE NO.,5-19- 7.9a- ,06819 Q 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/bdrm = 991 present x 110 gal/bdrm Garbage Grinder Installed yes no Spa or Whirlpool Installed yes no 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) TpRoszKaphy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water SUpply <f a sand at what depth at what depth Cunicz a Rolling loam feet feet well Steep slope clay A 11r- if well; water supply Yo 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: F o New Construction: All individual sewage disposal systems must be designed by a licensed r 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) Tile Field: each trench 150 ft Total System Length: Seepage Pit(s): number of size of each: _ft. by 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: 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 13 6-29 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 th(;Town of Queensbury Sanitary Sewage Disposal Ordinance. Signature of responsible person Date :it!tvcrs .tall sew.tilt. Disposal t'IInI)fer A 1.iaOUP'TION. Ii'l liji,l.) FAIARATION It1PA 11;; - -- --�/; - POND ��i ts'ra•./ I t. 1 �•j iht iYG t+lYr(7fLP11K'l�. F`I Rt_!S 7. SIGNATURE &INFORMATION FOR Application for Permit— Mobile Home Town of Queenshwy, 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 Name: x+° R R-A)e_ '4­01 File Permit No. A,ddress: Fee Paid 0 C �4 2002 n Reviewed 1�y: ;,;j_.; _ Phone No. Parcel Information Property Owner Information e—_/ -Proposed Date of Placement: Name-:- _-,_j- Frl-eq -f We 6 a,-&6 kt-)s o n Property Location: .2E,_4S Address: /0, z-1-elsf bdl1�e, Road,Street,Avenue Name of Mobile Home Park: f Yfapplicable) '300, Phone No. �l ax Map umber Mob" ome In o afiond,� Zoning Information '!A /Ak Approximate Value f Home- LOV 0,,g4� Zoning Classification: New Home: Yes Size of Property: 96.�9 ft.by LIM& Replacement Home: Yes Existing buildings: No A Size of Mobile Home: P4 ft. by TO ft'. Setbacks: front yard_ & ; rear yard ft. Singlewide: Doublewide: Side yards fL and ft. Number of Rooms: (exclude baths) 6 - Number of Bedrooms: Accessory Building(s): circle Number of Bathrooms: car;(��D car X�Wood � Detached garage:ood F�� circle: Gas Fireplace Woodstove Fireplace Attached garage: I car; 2 car, car Storage building: (Ej) No Foundation Support: Other: TYPE SIZE&D= Water Supply. well or �mci�pal Piers x Runners x x 14 (S Is Septic Permit Required? s or No uy Further information requested on the reverse side of this sheet 000' 4q Name of Installer or Mobile Home Dealer; �-�Xi77__i _H �C .J7 �. Address: y"', al.1, a LyLkfn-_1J,_" -1�- 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. t 3. Plan Approval Number: 4. Model or Component Designation: /V A (New Home ONLY 5. Date of Manufacture: 1 9 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: / owAer,owner's agenfjarchitect,contractor Special Conditions of Permit By. Form: 11/19J1999sh Code Enforcement Officer ' �LqProject Name: BP# d Address: / Building Permit Submission Sing.fandy du dirzg 7, Tuofian dy dmUi g f Checklist OCT 11 All items below must be checked either yes,no or not applicable prior to su6hiissign of any bZt oWg permit to the Town of QueensburyBuilding Department. If any of the below items_are'lacking,the_perit will not be accepted until such time as the application is deemed complete for submission:s 1. Building Permit Application Completed ... ... ... ...... ... ...... ... ... ... ... . Ws no ❑n/a 2. Energy Form or CheckMate Energy Cade Compliance Forms Complete.. ❑yes ❑no ❑n/a 3. Energy Code Inspector's Report from CheckMate Program...... ... ... ..... ❑yes ❑no ❑n/a 4. Septic application completely filled out(if applicable)... ... ... ... ... ... ... ... Ws ❑no ❑n/a 5. Solid Fuel Burning or Gas Appliance Form... ... ... ... ... ... ... ... ... ... ... ... ([--]yes ❑no- ❑n/a 6. Electrical Inspection Form... ...... ❑yes []no ❑ 7. Two (2) complete sets of structural drawings... .. ...... ... ... ... ... ... ... ... ... . ❑yes ❑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.... ... ... ... ❑yes ❑no ❑n/a location of well or water lines,location of septic system or sewer line. 9. Setbacks from property lines to new structure... ...... ...... ... ... ... ... ..... ❑no ❑n/a 10. Setbacks to neighboring wells and septic systems,including onsite well.... ❑yes Qno Qn/a and septic systems (if applicable) 11. DrivewayPermit... ... ... ...... ... ...... ... ... ... ... ... ...... ... ... ... ... ... ... ... ❑yes ' ❑no ❑n/a Date: ��I j ID ,.-,... Staff Initial: L:\Sud-k i uMing.Permit.FORMS\Generic Checklist.doc IF=H AM,R---il PPAR SSE=M=—M=-V-B C21" FMMW=4=FM-V- .00- Town c)f Ctuig nst>ury Ouilcflno Zk 4=cmJ4o E=nfaro,4am4ent 742 Oety F:Ic>c-xO C:)Ue nsboury, NY 12804 (S1 8) 761-8Z56 BATE INSPECTION REQUEST RECEIVED: Ar- Af stippcort, pier spacing perixuwnxlr. ........................ 2. axxc-UcwilmS per rriarxxxF- --------------- 3. vvntt--r lilac,- shut,off ................... . 4- at--vvf--x- lixxf-- support <j2> 4 feet ------- 5- lxciatirxg crossover (CItAovvidf--) clffgrcl- 6- CIx-ye--x- -vt--lmtecl CrutsicIf-- ---------------------- 7- - SICix-tirlg ventilated -------------- ------ S. IIC:)It water 3rt--Iif--f valve Pijpi]MH outsidev Ste--P&, railing -------- vvz&tt--r- -------- five-- prcxz),f ilao .................. 12. cicx3r closers .......... .... ............. 13. plumbing fracture-- ---------------------- 14- ft:)xjjmcLviti<3xx insxalcMion (if gtyq::ol-)------ 15. &rlm<ACt-- datf--<--t-C>rs ....................... 16. final electrical ________________________ 1'7. variance ve,qxxix-eNd --------------------- I.S. data pIELtt-- c:)"y ------------------------ 19, mobile I-rLJIE> seal cl"y -------- ------ Manufacturer F�N�AL IEEi����CT�f�>� i�E�CiiPlT J 6 �1�lJLAR -town of Queanst>ury Building 8L Cod+B Enforc4am4ent 742 Oety Ftcaax] C luransbrury, NY 12804 (518) 76 1-8256 M D�iTE INSPECTION REQUEST RECEIVED LC?GATION: CiiJ DATE: �� PERMIT # C)O, -2 192 AY��YII..E gI®A+YE �+®Ia�JLAli. HI011rYE FtX7TINGS FC?LFND.ATIt�N SAC�KFILL FRA.MI3riG NfA. "YES NO i. foundation support, pier spaci.xYg perrxuwmtlf. ........................ 2. anchoring per rnanuf. --------------- 3- water line shut off ------- ----------- - - 4_ sewer lirie support (a� 4 feet 5_ heating crossover {dblewid8�) off 6- dryer vented outside ---------- --------- '7_ sl�rtir�g ventilated --------- ------ - -- 8_ hot water relief valve piping ou 9- deck, porches, steps, railing ----._-_ 1©_ fu.rrmcefhot water operating -------- -- - i1_ garage fire proofing ------------ ------ 12. door closers ------------ ------- --- ----- 13- plu.rnbing fIx.ture ------ 14. foundation iaxsulatioxi (if appl-)-.---- 15. smoke detectors ....................... OP116. fii al electrical ........................ va.riatxce required ............... ..... . data plate okay ....................... 19. nao'bile Hul:> seal okay -------------- Model # - Serial # Manufactcu-er Date of hiiariufacturer OKAY TO ISSUE CIO YES NO ' �"` Coxxx�ments: �' C-" - COMMONWEALTH ELECTRICAL INSPECTION SERVICE, INC, }fain Office 176 Doe Run Road - Manheim, PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL i N � Permit No.4#ilfftft,ntfff#a.autfrtffrf##fRfaa�e�+ � Cut-in Card 1 o.J2534 Yi*14rf+i,rui4raurri„fr,frifff� '++ *}•,e 1if.liH.filfi#ti }IIHM#f1iiHMf###lil#Mi##4!,#Moff „f„g4.,iq, r ## Ifflitt#fffffa#Rifoif,.YriYRiff,ff,f44f{1If„l„l4ffr4fft#ff 4118810080181f ft41 iN#I###1 ! Location...... .... }Y,.R.r..,.r,f/4.rii4Y,4R}i}fof off off ltM#IMIMM IMII„f.11rr{frrMI I11##I M,flff„f,rf,rMi{rli#M4ffrr 114IY,rIMY/MMrri4#/##tI#Ni#Nrir {114YIfiffrlrirl �� � 61 ter 1jj f�f 9 Installation Consisting ti+j 4,!##IMItM,#IIMM#1,.## .#,f4,.i, MrY#IMta .rt4►f44f ifr.}if4,i,1#if#Nt#liif##IMtIMilMfr#IIIIMiI#f#H4#,r4Mf#####If4,iilrili#i# MI#Ill044 tool#Hfi/,tit#fNiffRf.of@plot, Norfo $ !#fY#tf+fr„I,.I}f#fN4MNHi.#4#foffIIaIf4l#i#t#f###f#III#.ifoa,f!##oeNf#ft#}N#f.#f}#It#.,f.04#t,fo.Nt#.}}tMfI l,fa I float toofiof NftfffirNifrara Hri{NY#farfr of 1**1 HiRIIHf#4$tof ff#ifllptHitr•irr too tool fl,flf###fi{f#ii11 i4iffff#NII.11#it i.#1#H###i##Mato#f4#if MI#.#######1 Installed By..1146616059.- Lie. No. iflfal,Yfiifir►l,iNr{Y�#rfrri.Hr{f N1lit#ffffll The conditions following governed the issuance of this certificate, and any certificate previously issued i cancelled, - This certificate only covers the electrical equipment and installation conditions as of date. Upon th( introduction of additional equipment or alterations, application shall he promptly trade for inspection. Inspectors of this Company shall have the privilege gic ' pections at any time, and if it rules are violated, the Company shall have the right gtoor, oc e#DateI IAo If#/Itoo i tota,frf,Nff4#ff RRf#fo#foolii,a,iINSPECT�/ f• f# rrr++4a1a#u.rrti+EIEI#1+flfr.il#r+frif#Ildrfrf#fi,i# MpmhAr N.T.P A.. 1_A.R.L Foundation Inspection Report Office No. (518)761-8256 Date Inspection request;received: Queensbury Building&Code Enforcement Arrive: am/p Depart• 11V anvpm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: ° j NAME: �— PERMIT#: LOCATION: ? INSPECT ON: — �— TYPE OF STRUCTURE: e, Comments Y N N/A Footings Piers ' onolithic Slab 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/Wallpour Reinforcement in Place b Foundation Dampproofmg Foundation/Waterproofing Type of Dampproofing/Waterproofing Footing Drain Daylight or Sump Footing Drain Stone: 12 inch width 6 inches above footing 6 mil poly for wet areas under slab Backfill Approval Plumbing Under Slab PVC/Cast/Copper Foundation Insulation Interior/Exterior R- Rough Grade 6 inch drop within 10 ft. L:\SueHemingway\Building.Codes,Inspection.FORMS\Foundation Inspection Report.doc January 28,2003 t Septic Inspection Report Office No. (518)761-8256 Date Inspection reque ree ' e : c . 7 3 Queensbury Building&Code Enforcement Arrive: a p. D part: 1 742 Bay Rd. Queensbury,NY 12804 Inspector's Initia NAME% l �M(L Y4 NO : -2, � LOCATION. l — _ SPECT ON: 7 U . RECHECK: Comments and/or diasr Soil T Sa Loam/Clay Type of er: Municipal/Well Water 1� Waterline separation distance m ft, i Well separation distance !ft. Other,wells: ft. \..1 Absorption Field: Total length t ep., ft. Length of each trench ft. Depth of trenches ft. Size of Stone -Seepage Pits: Number Size: x Stone Size: PiPin2 Size Type Buildingto tank i a' 10 % r�> Tank to Distribution Box l- Distribution Box to Field/Pjl, Opening Sealed: Y/N/ artial- Location/Separations Foundation to tank ft, Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Location of System on Property: Front Rear t Side Right Side Middle Front Middle Rear System Use St us: , Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved . LASueHemingway\I3ui1ding.Codes,Inspection.FORMS\Septic Inspection I2eport.doc January 28,2003 02, OCT 11 2002L ( OCT r 2002 r s rll�r f�: =z.r�{���c���• �+'1 v 64� •r f: r. ��� �`'�••�'�, I•,a Pue�I�Sa�+�`��e�i����:C�•O�a � � � ' shown ,.. et forth on the dlaram. .� �• �.; : r o all.,:Aa sure �'.tbe:distanoes s . . person, ...�, �';?►•; :'���:. �.:?�, ���' t' r I { tt •; is 1 N� iY w. • 1, QUE BUIL DING& �t ia.,Si,. 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