2000-264 BUILDING PERMIT
Town of Queensbury,742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 47088 Building Permit No. 2000264
TAX MAP NO. 127 . -4-15 . 2
WELLS, SAMUEL & NANCY
Permission is hereby granted to
Owner of property located 0% ILLINOIS AVE.
t
in the Town of Queensbury,to construct or place a 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 NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
MILLS RD.
QUEENSBURY, NY 12804
Contractor or Builder's Name:
SHO MOBILE HOME BROKERS
Contractor or Builder's Address:
USED MOBILE HOMES 3048 ROUTE 50 587-6704
SARATOGA SPRINGS, NY 12866
Electrical Inspection Agency:
Type of Construction- MOBILE HOME
Plans and Specifications:
Proposed Use:
MOBILE HOME
72 May 10 2100.2
$ PERNIIT FEE PAID—THIS PERNIIT EXPIRES
(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,)
10 May 2000
Dated at the To of Queensbury this Day of
SIGNED BY !NZA W for the Town of Queensbury
Code Enforcemefit Officer
Application for Permit— Mobile Home
Town of Oueensbury, 742 Bay Roam Oueensbury, 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: G 7 f € File Permit No. �/ !'lC7Q _ �� "t✓)
Amu g 1 _ rce l[� J
Address; . Fee Paid '
Reviewed By:
:.......... = ......................... ...............
Phone No.
MAY 0 3 2000
Property Owner Information Parcel Information
T OWN OF QUEENSBURY
Name:
Proposed Date of Placement: BUILDING AND C DE
Sa.vn.a f�P ����I�
Property Location:
Address: , Road,street,Aienue
Name of Mobile Home Park:
(if applicable)
Phone No. ! ^:S3 Tax Map Number: /�27 /
iMobtle Home Information - - ZoningInformatioiii - -
Approximate Value of Home: $ �l 1k
Zoning Classification: M(Z-:5
New Home: es No
Size of Property: (oC)_ ft.by 100, ft.
Replacement Home: Yes No
Existing buildings:
Size of Mobile Home: ft. by G ft.
/ Setbacks: front yard�_ ft. ; rear yard 10 ft.
Singlewide: Doublewide:", Side yards j o _ft.and IQ ft.
Number of Rooms:(exclude baths)
Number of Bedrooms: Accessory Building(s): circle
Number of Bathrooms: 02
' .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 r municipal
Piers x
Runners i x �— Is Septic Permit Required? CYes) r No
Slab x {
Further information requested on the reverse side of this sheet W
R -
Name of Installer or Mobile Home Dealer:
2 �
Address: 5W.� j (,
Phone No.�16_/ 6 0
;Complete information below found on a"plaie"or"sticker"which is affixed to the mobile home.
I.." . .Insignia serial nWber. /� ,��' ����� 5 �'`�'�If �
�.. i
L�2,246-2,,--l-Wo6
Name of manufacturer: ' .
r° 31� y. ;P1ain.Approval Number
4. Model or Component Designation:� /i��
(New Home 0MJ9
5. Date of Manufacture: C-
— —r;FFIDArV-1T_--_ -- -- _
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: ,,c2,4 bjuQ.4
owner,owner's agent,architect,contractor
Special Conditions of Pennit
By /d
Form; 11/19/1999sh Code Enfor ement Officer
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:
File Permit NQ,Z-69o�[D'C
Tax Map No. /27 '0 - 2 11
—
Fee Paid
Owner's Name: C&;C,r-n
................... .................... ................................................ ......................
Address: j,Z ff,6
(J any
2. INSTALLER'S NAME PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(y)and multiply# of
bedrooms,%Niith 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/bdrin =
1980- 1991 x 130 gaL/bdrm =
1991 -present x /1 0 gaVbdrm =
Garbage Grinder Installed yes no ✓
MAY 0 3 2000
Spa or Whirlpool Installed yes_ no
TOWN OF QUEENSBURY
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)LBUILDING AND CODE
-ObD
02 rah io��Iiture Ground Water Bedrock or linvervious Material er Supply
D
•and at what p1h municip-CIC—1
Rolling . eel feet well
Steep slope . clay if well;water supply
slope other from any septic-system
depth: absorption is_ft.
other
Percolation Test: . o be completed by licensed professional engineer or archiarchitect)
Rate:Percolation
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: Za-90 gallon (min. size 1,000 gal.)
Tile Field: each trench ft. Total System Length:
Seepage Pit(s): number of———:Z size feach: fl by ft.
Size of Stone to be used: # depth or thickness feet
Bed System Size: X
Alternative System: length andlor 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.
sigAzitLiKei of responsible person Date
GENERAL INS REPORT
(518) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804. Arrive am/pm Depart' ` am/pm
Inspector's Initials
NAME: Gt i'' LS PERMIT# 20
LOCATION t DATE: j
TYPE OF STRUCTURE:
RECHECK
/110 N/A YE NO COMMENTS
Fgo lPiers I
anolithic Pour Fo
Reinforcement in PI e
The contractor is sponsib for
providing protectio from ing
for 48 hours folio g the pla ement
of the concrete.
Materials for this purpo on sit
Foundation/Wallpour
Reinforcement` Place
Foundation/Dampproofing
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Pla
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior
Foundation Walls Exterior -
Floors R-
Walls
Ceiling -
Duct work or piping in
unheated spaces R-
Proper Vent, Attic Ven
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
Fire Wall 2, 3,4 hour
Firestopping
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