1999-088 i r ' ''
RECEIVED
0. • MAR 2 5 1999
r�-.oWN nip .IOWNOF
Q IJI:.1�,1V,S,f3 U�1Z�' Qu�ENs�urr;,
QUILDING AND CODE
REVIEWED BY:
FEE PAID: ._ 55 —Y
APPLICATION FOR PERMIT 7 9_QsT
MOBILE HOME OR MODULAR
A BUILDING PERMIT MUST BE MAIMED BEFORE PLACEMENT OF MOBILE HOME.
NO INSPECT1ONS WILL BE MADE UNTIL A VALID BUILDING PERMIT HAS BEEN ISSUED.
The owner of this property is: /2624— „, (
;/:2,,X /
P.O. Address: Phone Number
Property Location�Ut 4,;/-/i/e5-4L// /4
NAME OF APPLICANT: i) P Ui--/O f-1___ I t ,51)-(a(p
Address of Applicant: L.) ,(-45---c7/756:7 c ,2 S /)Y /42 Y-u -5)
All applicants spaces on this applicatlon MUST be completed and the
signature of the applicant MUST appear on the reverse side of this application.
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PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES:
MOBILE HOME INTONATION
I NNIOXIMAIE VALUE OF HOME: $ /// 9C10 .
New Home Yes No
0 - ING INFORMATION:
Replacement Home Yes v q
S ze of Property: w d ft x /20 ft
Size of mobile borne / iflx2 1ft
jj Existing Buildings: v41/0177�-----
Singlewide __ Doublewide
No. of rooms (exclude baths) Proposed building-distance from property line:
Front Yard 442 ft Rear Yard /0 ft.
No. bedrooms- ,7 Side Yards /U ft and ,...3 f t.
Occupancy Information:
Nu. of bathrooms
Primary dwelling: Yes No
Fireplace _Woodstove G&
Acces�ory Iluilding(s) .
Del3sl.ic lI garage (on r /two car car)
Foundation style and size:
Attached y�rb (one car_`/two car car)
Storage b9dl�llrry\
Piers-No. of Size ft x
ft Other
Depth below grade_t
�� * * * * * * * * * )I( 4( AA4( * * *
Foundation-Footing size " x
Wall nrateria' ���� ' Proposed date of placement:
--- —:
GCS
Wall thickness4 " Height-2.�'" Water Supply: Well Municipal K
Total depth below 'grade_- 0 ft. Septic permit required? k)
Grade Lo home floor. levelft.
-TPA 6.( ‘Iti_frn I'D
vi
FURTHER INFORMATION REQUESTED ON THE REVERSE SIDE OF THIS SHEET
NAME OF INSTALLER/MOBILE DOME DEALER: • Yf �l4 ///C1j51// // .,4.e> _
ADDRESS/PHONE NUMBER 3 Cc`S�=i // 14 ,J; ./,/.4,h s. , ,, /- $3
s7s 9j .-/2 .
STATE OF NEW YORK DIVISION OF HOUSING ANI) COMMUNITY RENEWAL
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
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1 : Insignia serial number 0 ,2C 7�
2. Name of Manufacturer _______C7=E!entOMPLIgle._______JX:1 / /7
3. Plan Approval Number
4. Model or Component Des 1gnaLI on. • _ —
5. Date of Manufacture j7/ /76' •
Al ] the above in forma Lion is to be found on a plate or slicker which
should be affixed to the Mob I 1 e Home. Complel:e above w1t.II that 'In forma IIon.
.
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Town of Queensbury Stale of New York •
County of Warren
AFFIDAVIT '
I swear Ilia I to the best of my knowl edge and belle f the s to tenter)Is contained
in Ibis applIcaLion, Logether wil:lt the plans and sped ficalions subialt Led,
are a true and comp e Le s La temen I: Of al I proposed work to lw, done on the
described premises and Lb I: all prov1s1ons of the I11111..I)ING CODE , the ZONING
(IIIDINANCE, and all other laws pertainlug to the proposed work slut I I be comps led
WI Lit, wlieliter sped f led or not , and that: such work Is alll.horized by the owner.
Signature
Owner, owner' s agent, architect:,
contractor
SPECIAL CONDITIONS OF PERMIT:
•
•
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By
Code rnforcemen1. Of Ulcer
DECLARATION: Please sign below of er you have carefully read the statement.
'I'o the best of my knowledge 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
Me described premises and IItat all provisions of the !Wilding Code, the Zoning Ordinance and all
other laws pertaining to the proposed work shall be complied with, whether specified or noted, and
that such work is authorized by the owner. Further, it is understood that I/we shall submit prior to a
Certificate of Occupancy or Certificate of Compliance being issued, an AS BUILT PLOT PLAN by
a licensed surveyor; drawn to scale, showin) •actual location of project on premises.
Signature: /..46,,..„,--Z (4i," '�-.
owner, owner's agent, architect, contractor)
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART: ); INSP
DATE INSPECTION REQUEST RECEIVED:
NAME: 6 u.(2.I6e-) 7
LOCATION: La'' ( gitic:6;e:,90
DATE: PERMIT# 1 f'19� J
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION _ BACKFILL_ FRAMING
N/A YES NO
1. foundation support, pier spacing
per manuf. — — —
2. anchoring per manuf. — — •
—
3. water line shut off — —4. sewer line support ®4 feet _. •
5. heating crossover (dblewide) o 'grd. —
6. dryer vented outside . —7. skirting ventilat — /
8. hot water relief alve pip',g outside — %(
9. deck, porches, ste.s, rai g —
10. furnace/hot water o.•ra g I —
11. garage fire proofing .. '... / — —
12. door closers13. plumbing fixture -
14. foundation insulatio (if appl.) —
15. smoke detectors16. final electrical17. variance requir•, — — —
18. data plate okay — —
19. mobile HUD s,:1 okay — /— —
Model #10 FV.5 6 Serial # FiR—1P 30 C.
�t IA)I'G- d2_ 7 Z
k 6
Manufacturer - L(�&
rr
Date of Manufacturer l p 72-e/ 9,
+/-
OKAY TO ISSUE C/O YES NO
Comments: (9 - 4 HA) VAptA App,e ,1-6_ T✓`
S co i hk / ) :z AJ RAT) NCB
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.(
Main Office 176 Doe Run Road-Manheim,PA 17545 a�
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL 0
Panel Board No _ Cert. N4 66087 Cut-in Card No.
Owner 0 C67 "272)k� r�
Location T 9 7 /49 tS rEfrb 1//L' ''//
Installation Consisting of �0//4-67 I 9)V1G g e [� e_ 0 4./C.1
Installed By `J'`L16 Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of mak' inspections at any time, and if its
rules are violated,the Company shall have the right
tor,�yoke t tifi etop
Date ` INSPECTOR •
(\) d Y-j2fkkr
FINAL INSPECTION REPOR
MOBILE I. MODULAR i1 IQ a ,
Town of Queensbury WOID;1 /6
Building & Code Enforcement '.
742 Bay Road 1 /
Queensbury, NY 12804 3 _
(518) 761-8256 3-
ARRIVE: DEPART:G d- INSP:
.—PI --N-SP2
DATE INSPECTION REQUEST RECEIVED:
NAME:
j � 4
LOCATION: f
DATE: 3- in ---91 PERMIT.N l
MOBILE HOME MODULAR HOME L'
GS FOUNDATION BACKFILL_ FRAMING
FOOTINGS
N/A , YES NO
1. foundation support, pier spacing
per manuf. — _____ —
2. anchoring per manuf. — — —
3. water line shut off — — —
4. sewer line support ®4 feet — —
5. heating crossov ( lewide) off grd.
6. dryer wilted outside ..: — — —
7. skirting yentifated 7 — — —
8. hot watet/relief vawe piping outside — —
9. deck, pohes,(steps, railing — — —
10. furnace/h cater operating — — —
11. garde fire proofing — —
12. dyer closers — — —
13,plumbing fixture — — —
14. foundation insulation (if appl.) — — —
15. smoke detectors _ —
16. final electrical — — —
17. variance required — — —
18. data plate okay — • — —
19. mobile HUD seal okay — — —
Model # Serial #
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments: is I_06_ 1 h ()CL U cq%C 0
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