98-097 MEMO
CERPURCA I CIF OCCUPANCY
Y
TOWN OF QUEENS13URY
WARREN COUNTY, NEW YORK
April 15 98
[� Date 19 —
� s. ` ` rr 98097
This is to certify that work requested to be done as shown by Permit No.
has been Completed.
MOBILE HOME
This structure may be occupied as a
LOT 117 ADIRONDACK STREET 9 `` D UAI eY { ,A
LA=ation ati�`- f�_ 1�
Owner HCWAIN . ARTHUR
TAX MAP NO * 9 3 . - Z - 1 1 11 By Order Town Board
TOWN OF QUEENSBUR Y"
Director= �o"f Bldg. & Code Enforcement
BUILDING PERMIT
VALUE $ ar TOWN OF QUEENSBURY No, 98e97
TAIL NAP NO . 93 . - 2 - 11 . 1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to MC1iAIN • ARTHUR
OWNER of property located at LOT 117 LUZERNE RD . Street. Road or Ave_
in the Town of Oueensbury, To Construct or place a 140BILE 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 Town of Queensbury Building and Zoning Ordinance_
t. OWNiEWS Address is
LOT 117 HOMESTEAD VILLAGE
+QUEENSHURY , NY 12804
2. CONTRACTOR or BUI LDER S Name
GLENS FALLS MOBILE HONE INC .
3_ CONTRACTOR or BUILOERIS Address
39 SARATOGA RD
GANSEVOORT , NY
4. ARCHITECT'S Nail
S. ARCHITECT'S Address
6, TYPE of Construction — ;Please indicate by X! MOBILE HOME
I I Wood Frame C I Masonry f l Steel C !
7. PLANS " Specifications
3. 61 tM. 70 r MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
MOBILE HONE
41 Apr i 1 3 20100
$ PERMIT FEE PAID — THIS PERMIT EXPIRES 19
(I t a longer period is required an application for an extension must be made to the Buildirg and Zoning inspector of the
town of aueensburY before tlx expiration date.!
3 April 1 �
Dated at the Town of Queensbury this Day of l9
`^ !+SIGNED BY
Building and Zoning Inspector for the Town of Queensbury
L ' y e
WN O�[ , Q LI; ITS I3 U� " ' MAR 31 JM
TOWIN Of-
REVIEWED b Y : BULUINfG ,AND CGUE
FEE PAID *
PERMIT NO , —
APPLICATION FUR PERMIT
MOBILE IIOME OR MODULAR
A BUILDING PERMIT MUST BE OBTAINED BEFORE PLACEMENT OF MOBILE IIOME ,
NO INSPECTIONS WILL BE MADE UNTIL A VALID BUILDING PERMIT IIAS BEEN ISSUED .
The owner of this property is : - .
P . O . Address : --y
�� -'�-'�5' -���; �'� L[, a G' � 11� �f'li o n e Number e'7 .�- .�-4rC+ b
Property Location Tax Map No .
NAME OF APPLICANT : C
Address of Applicant : 1
�V A
All applicants spaces on this application MUST be completed and the
signature of the applicant MUST appear on the reverse side of this app
PER R PONSiB F / VED
SION OF WORK AS REGARDS BUILDING CODES :TWGIF #
R31Im
TOWN OF a-JEEN, )E�LqRy
MOBILE HOME INFORMATION APPROXIMATE
A!o U!t) DE
�-� 111*I'IIOX I MATE VALUE OF tIOME a
New !lame Ye No ZONING INFORMATION :
Replacement home es ) No Size of Property : ft x ft
Size of mobile /borne �ftx�t Existing Buildings :
Singlewide L Doublewide
No . of rooms ( exclude baths ) Proposed building- distance from property line :
Front Yard ft Rear Yard ft .
No . bedrooms 3 Side Yards ft an6 ft .
No . of batlrroonrs Occupancy Information :
Primary dwelling : Yes No
Fireplace Woodstove Accessory Building ( s ) •
Foundation style and size : Detached garage one car / two car car )
Attached garage ( one car?/ two car car )
Piers-No . of Size ft x eft Storage building
Other
Depth below grade ft
Foundation-- Footing size " x '+
Wall material Proposed date of placement :
Wall thickness." height " Water Supply : Well MunicipalL/
Total depth below g.rade ft . Septic permit required ?
Grade to home floor. level ft .
FURTIIER INFORMATION REQUESTED ON TILE REVERSE SIDE OF TUIS SHEET
NAME OF INSTALLER/MOt3 I LE IIOME DEALER
ADDRESS/PHONE NUMBER
STATE OF NEW YORK DIVISION OF DOUSING AND COMMUNITY RENEWAL
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
1 . Insignia serial number
2 . Nawe of Manufacturer
3 . Plan Approval Nuniber '"q
d , Model or Coniponent Designation
5 . Date of Manufacture
All the above information is to be found on a plate or sticker which
should be affixed to the Mobile 110111e . Comlll e Le alcove with Lira L i n f o rma L I on .
Town of Queensbury SLaLe of New York
County of Warren
AFFIDAVIT
I swear that to the hest of my knowledge and beltef the sLatewents contained
in this application , together with the plans anti specifications submitted ,
are a true and cornplete statement of all proposed work to bq. done on the
described premises and that all provisions of the BUILDING CODE , the ZONING
ORDINANCE , anti all other laws pertaining to the proposed work shall he complied
with . whether specified or not , and that such work is arrLhorized by the owner.
Signature. ° ` —r —
Owner , owner ' s agent , architect ,
contractor
SPECIAL CONDITIONS OF PERMIT :
By
Cade - nforcentent Off cer
DECLARAHON• Please sign beloty after 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 clone 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 compliers with, whether specified or noted , and
that such work is authorizes) by the owner. Further, it is understood that Ilwe shall submit prior to a
Certificate of Occupancy or Certificate of Compliance being issued, an AS BUILT PLOT PLAN by
it licensed sure or; av✓n�t`o scale, showing actual location of project on premises,
Signature: �-
(owner, owner's agent, architect, contractor)
IF IPJALL 1P4=1=W=1r1C3r4 Fe ra sic r
WILE / MOCXUL Akn
s Town of Queensbury
Building irk Code Enforcement
742 Bay Road
Queensbury, NY 12804
(618) 761-8256
ARRkVE_ 12�-t j EPART. 1NS
DATE 1NSPECT10Nf REQUEST RECEIV Do
NAME: A �,T HL� R C > >�kk "
LOCATION: �
—��� �¢Ca1 'a _ �
DATE: % � AS 9AL — PERMIT #
MOBILE HOUR MOEKJ] &R HOME
KXsr1NGS _ F )UNDATION RACKFns. r FRAMING
NI YES NO
F
7per
support, Pier spat
anuf.P monad.shut,off .. ... . .. .. . .. .. .. . /support a 4 feet . . .. ..5. "�ver db de)
dry Cv +/ /
7, - skirting v+sxstilated . .. .... ✓/S. hot water relief valve pip g ou _ ✓/
94 deck, pcwches, steps, rai .. .
10, furnace/hot water operating
I I. garage fire proofing .. .. .. 9 1 1
-
12. doom closers .. .. ... .. ... .. ..
13. plumbing Picture .. .. .... ��['/'f✓
14. foundation insulation (i appi.). ..
15. smoke detectors .... ... .. .. .. . I. t/
16. final electrical. . .. .. .. . ..
17. variance-required
18. data plate okay .. .. . .. .. .. .. . .. .. .. . ✓�' ,/'
19. mobile HUD okay .. .. ... .. .. .. .
Model # tse�
Nfanufactur�er ? .
Date of M ufacturer .
0 Y- To ISSUE C/o YES ND
Comments:
THE NEW Y+O' RK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
III WASHINGTON AVE. , SUIT ALBANY , NY 12210
!E 1 : 1 1 . 1 ' .. I k.a`+>j S. 3i ;`•. 51"'dt / 'i?•, I
Date Apppplirarion No' file
THUS CERTIFIES THAT
onl�r the electrical equipment as d"cribed below and introduced by the named on the above application number in the premises of
Fi`!'kiS.i}c 41i''lJ.%'. l II . 1 3 kIC4113'i._.'1'F1 ] Il Y c';E4 . (,3E.1Fi$1 }}111; 'I' , iJ ' '
inthefollowinglocation: ❑ Basement ❑ lot Ft. 0 2nd Ff. -it fill Section Block Lug I (
}. } , .} el. } '�`
eeaA examined on ,rand found to be in compiiance with the NaRianal Electrical Code-
FIXTURE RXTURES RANGES COOUCING DECKS OVENS I DISH WASHERS EXHAUST FANS
ECEPTAClRS SYVITCttES
OUTLETS INCANDESCEM' , OUJORESCENT I OTHER AMT. 1 K. W. AMT. K. W. AMT, K.W. AMT. K. W. AMT. H. P.
DRYERS FURNACE MOTORS FUTURE A►PUANCR FEEDERS SPECIAL MWIFT TIME CICICK5 �, UPIt7 HEATERS MULTITEMS ET IS'IMMERS
SYSTEMS
AMT. K. W. CAL H. A. GAS II, P. AMT- NO- A. W. G. AMT. AMP. AMT, AMPS. TRANS. AMT. H. P. NCI.. CIF FEET A'�T- WATTS
SERVICE DISCONNECT NO.CK S E R V L C E
AMT- AMP'. TYPE SEW 1 JF sw f / SW S X SMr S,e �W ' CRCOND- Of CC. CONP- - ' HULEG OF MI LEG ` ' Or '"TEALS ( U RAt
OTHER APPARATUS:
1�I �F�I '1}''1 : # _'. q •d 4'F�:I �I F � }t '}s '{`�. ! I1ki I
�I
;
r l 1' �1'1`i yr 7 1: }i} '. . RiEh1ERAL MANAGER
:;iFl: ifs`:%ri+.:}d'1' , I•F'i I .:' >'. S #
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BLUILDING DEPARTMENT . THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
F1NAt INSpEC'M'IOIV IF1>EParrat�
MC 0ILME / MCdGOUL..AR
Town of +Queensbury
Building & Code Enforcement
742 Bay Road
Queensbuary, NY 12844
(518) 761-8256jj } ,/]
ARRIVE: EPART: C f NSP: �..1 1C- C
DATE INSPECTION REQUEST RECEIVED:
NAME: C., " i 0
LMATION: t4-
ql
DATE: PERM # t?
M108I1LS no MOD[TLA dF1omM
FOtOT>IVGS FO ATION BACKFMI., FRAMING
NA YES NO
1, foundations Per spacing
per manuf: . .. .. .. . ., ..
anchoring per Ufa
. ». .. .. ..... . . . —
3. water line shut, o . ... ..
4. sewer line support 4 feet
5. heating crossover ( ewide) off
6# dryer vented outside .
7. skirting ventilated . .. .S. lint water relief valve pi g ou
9. deck, porches, steps, rat a.. I. . —
10, furnace/hot water operating - —
11. garage fireproofing ... .. .. .
» .
12* door closers . .. . .. .. .. .. . . . . . .. .. . . ..
13. plumbing fixture . .. .. .. ... .. . .. .. ..
14, foundation insulation (if a i.), .. ...
15, smoke detectors . ..... .. .. .. .... .. .. ..
16* final electrical .. .. .. . .. .. . .. .. . . . . . ..
17. variance required .. .. .... . . .. ..
». .. ..
IS, data plate okay ..... .... . . . ... .. .. .. . _ —
19. mobile HUD seal aka
Model # iY Serial #
I
Manufacturer
i
Date of Manufacturer'
F
Y TO IJAUE CIO YE5 NO
ts.
FINAL IfhISr�ECT'1t�IV I�c1_r���-e�r
MOif31Lt / IMC3C3 ILAF1
Town of Queensbury
Building & Code 'Enforcement
742 Bay Road
Queensbury, NY 12804
(618) 761-8256
ARRIVE: �EPART: 1NS
DATE INSPECTION REQUEST RECEIV
NAME; - V t., t"'oyntsx-'
LOCATION: c�Ff � ►•
DATE;
PERMIT #
M0811LE l4aaoms MODUZOAlK HOMB
FOOTINGS ! FOUNDATION . SAME � FRAN41NG
N/A YES NO
1, foundation support. Pier king
per, manuf.. .. .. .. ... .. .. .. . . . .. ». .. --
2. anchoring per manuf.
3. water line shut,off —
4* sewer line support 4 f --
5. heating crossover (dblewide o grd. --
6. dryer vented Outside . .. ... .. .. ... .. .. .. .
7, • skirting ventilated ..... .. . — —
8» hot water relief valve pi o de
9. deck, potches, steps. 9 .. .. ., .
]0» rpacellrot water ting
fu
11» garage fire pr°o --
12. door closers . .. ..: .. .. ... .. .. .. . .. . . .. . —
13, phrmbing fixture .. . .. .. .. ... .. .. .. .. . .
14. foundation insulation (if appl.). . . .. .
15, smoke detectors .. .. .. .., .» .... . .. .. .. .
16. final electrical .. ».... .. .. .. ... .
17. variance required .. .. ..... .. .. . . ... .. .
19, data plate okay .. ... I . . I . . .. .. .. .
19, mobile HUD seal okay .. . . .. .. ... ..
Model # serial #
Manufacturer .- % !B97= + -�
Date of Manufacturer '� 1 ■ ryD
OKAY TOE YES NO
C'onunents,
i
TOWN OF QUEENSBURY
U L. °' MEW
E "` - " , ri �vrt n� Qu��t�s11 sullu++ c�>+
Based on pur Limited examit�s0"s
EV V`J Y Gp{npilance wtth 4Ui CCT1 nwft` $MR
_ t,pt be construed as indicxtirigtt+e
Lae plans and speciticatians a►8 iri Full
_ _--. e,,,,,pjiance with the Code.
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