1999-681 •
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Notren her 1 A 19
This is to certify that work requested to be done as shown by Permit No. 00 e 0
• has been completed.
This structure may be occupied as a MOBILE HOME
LOT 37 #60 SUGARBUSH ROAD
Location
Owner SMITH, RUSSELL
TAX MAP NO. 9 3 . —2—9 By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518)761-8256
VALUE $ 45000 Building Permit No. 99681
TAX MAP NO. 93. -2-9
•
Permission is hereby granted to SMITH, RUSSELL
Owner of property located at LOT 37 #60 SUGARBUSH ROAD
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.
Owner's Address:
LOT 37 #60 SUGARBUSH ROAD
QUEENSBURY, NY 12804
Contractor or Builder's Name:
TODAY'S MODERN HOMES
Contractor or Builder's Address:
54 RT, 9 .
GANSEVOORT, NY . 12831
• Electrical Inspection Agency:
NEW YORK BOARD
NEW -YORK ,BOARD OF FIRE UNDERWRITERS .
Type of Construction:
MOBILE: HOME . .
Plans and Specifications:
1456 : SQ •FT. MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS
' Proposed Use:
MOBILE HOME
90 November 5 . 2001' "
$ PERMIT FEE PAID-�THIS PERMIT'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.)
5 November . 1999-
Dated at the Town of Queensbury this Day of
SIGNED BY �_ for the Town.of Queensbury
Code Enforcement cer
TOWN OF QUIEENSBURY
742 Bay Rd., Queensbury, NY.12804
APPLICATION FOR SOLID, FUEL BURNING APPLIANCES AND CHIMNEYS
Date ,19 7 7Permit No. / 1 �" r '
f
APPLICATION IS HEREBY MADE to the Building Dept. for the issuance of a Building and Use Permit
pursuant to the New York State Fire Prevention and Building Code. The applicant or owner agrees to comply with
all applicable laws, ordinances, regulations, and all conditions that are part of these requirements and also will allow
all inspectors to enter premises to perform required inspections.
Please fill out additional form if more than one appliance and/or chimney.
Applicant ` 04 '/1iOi eiz,/ 147104 elf APPLIANCE (check appropriate boxes)
Address 4.. ❑ STOVE: ❑Wood o Coal. o Pellet o Gas
0 FIREPLACE INSERT
,is 17- ' 4} Zip /0 31 rb FIREPLACE, FACTORY-BUILT:
° Wood ❑ Gas
Phone 7I /O 3 a 0 FIREPLACE/MASONRY:
❑ Wood ❑ Gas
Owner a . .set( ,,, ,n.//-7.# , - 0 FURNACE: ❑ Wood ❑ Gas •❑ Oil
Address 77 Sue4 .640J/, er" P IF NON-MASONRY APPLIANCE:
- Manufacturer: F ilei . - -
iAd1ir- r v API Zip d 8oV ' Model: 1 CC M t1
Phone
CHIMNEY (check appropriate boxes)
*EXACT ADDRESS of proposed construction
IV 0 V/ AA44 J 'ot' e ►) 0 MASONRY: 0 Block 0 Brick , 0 Stone
7 Soo4'7, f/ ' fr,04.i7FLUE: ❑ Tile ;Q Steel
Size: inches
CONSTRUCTION / INSTALLATION MUST 0 FACTORY-BUILT:
CONFORM TO NYS FIRE PREVENTION & Manufacturer: rivi I Model: ()V-OPtsi
BUILDING CODE. CONSULT AVAILABLE Listed By: to L Number:,14 36 93
TOWN OF QUEENSBURY HANDOUTS ® Double Wall 0 Triple Wall
REGARDING REQUIRED INSPECTIONS. 0 Insulated 0 Direct Venting
o Chimney Liner
Cashier's Department Town 'of Queensbury, New York
Dept: Fire Marshal Amount Collected Amount Refunded
Code Number Title
A 173 3389 (190),Public Safety
A 233 2655 (230) Minor Sales
µ B
Fee Collected�From o efunded to: /.. ti '3 f l� :.- c �i ' '"
Address: i ;) v t ' V a
Dated: //)/,s, , g c' Town Clerk or Deputy:
White: Applicant Green: Fire Marshal Yellow: Bldg. Dept. Pink & Goldenrod: Cashier's Dept.
•
(.1. 1a • TO WN OF QUEENSBURY
"FO: 6841
REVIEWED BY: Y
FEE PAID: $
PERMIT NO.
APPLICATION FOR PERMIT
MOBILE HOME OR MODULAR
A BUILDING PERMIT MUST BE OBTAINED BEFORE PLACEMENT OF MOBILE HOME.
NO INSPECTIONS WILL BE MADE UNTIL A VALID BUILDING PERMIT HAS BEEN ISSUED.
The owner of, this property i s: ,Q-7/1
P.O. Address: L o zcc j I o4 Phone Number --79, -‘.9,30
Property Location 37 St46.14d(.,IJI.1�Lr479 4k-6 Tax Map No. 93, /�-q/ 7
NAME OF APPLICANT: aosJtZL cJ/t ?f7// -- �c�0.9-':1 4 O ' 1 rid 1'
Address of Applicant: Sy ,40u76 9 , 64,✓f6/.9o,27 4/1 f2e /
• P # INI D -
All applicants spaces on this application MUST be completed andI(e, o 1 1999
signature of the applicant MUST appear on the reverse side of this application.
PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES:T`B7'6t AfiERY
MOBILE HOME INFORMATION 'APPROXIMATE VALUE OF HOME: $ J 0°0
New Home • No 1 1.1-5rp ZONING INFORMATION:
Replacement Home 'Oho Size of Property: Slc- ft x JO ft
Size of mobile homeyltx st Existing Buildings:
Singlewide Doublewide
Proposed building-distance from property line:
No. of rooms (exclude baths) `j Front Yard • 2s' ft Rear Yard 27 ft.
Vo. bedrooms Side Yards / 9 ft and ft.
go. of bathrooms Occupancy Information:
Primary dwelling: 9 No
=ireplace )( Woodstove Accessory Building(s) :
outtdatiort style and size: Detached garage (one car /two car car)
/I�j� Attached garage (one car /two car . car)
'iers-No. of Size it x ft Storage building
Other
Depth below grade ft •
* * * * * * * * * * * * *
'oundation-Footing size " x "
Proposed date of placement:
-
'all thickness " Height " Water Supply: Well Municipal X
otal , deptl.i below grade ft. Septic permit required? 4 - 6-Y/S'/ /( .
rade to home floor. level32."ft.
FURTHER INFORMATION REQUESTED ON THE REVERSE SIDE OF THIS SHEET
•
NAME OF INSTALLER/MOBILE HOME DEALER: v�',,.M /WPC-,/ 6=1
ADDRESS/PHONE NUMBER Sy ` 2 1 C5-9nJ.l6--7"o0/27 /ill /2 S/
7 96 - /o c'C C vz 7 —/O ;/�t/ -
STATE OF NEW YORK DIVISION OF HOUSING AND COMMUNITY RENEWAL
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
1 . Insignia serial number CA/0 - 69 -Z L-f-Cs
2. Name of Manufacturer Sk�G/y'Lc - E/ /"/ 42.., ,
3. Plan Approval Number �S'3
4. Model or Component DesignaLion S Y7e7(7 ' C
• 5. Dale of Manufacture Z.VZJ/519
All the above in forma Lion is to be 'found on a plate or slicker which
should be affixed to the Mo bile .Home. Complete above with Lha 'In forma IIon.
•
•
Town of Queensbury •Slate of New York
County of Warren
AFFIDAVIT •
I swear that to the best of my knowledge and belief the statements contained
in this application, together wilt the plans and specifications submitted,
are a true and compl a to s la Lenten t of al 1 proposed work to bp. done on the
described premises and that all provisions of the Illlll_DING CODE, the ZONING
ORDINANCE,, and all other laws perlainlnd to the proposed ork shall be compiled
wl tar, whether spec] fled or not, and that such work is authc razed I y the wner.
Signature
Owner, o rer' s agent, architect,
con trac to
SPECIAL CONDITIONS OF PERMIT:
By
C Enforcenren Officer
DECLARATION: Please sign below after you have carefully read the statement.
To the best of my knowledge the statements contained in this application, together with the plans
and specifications submitted, arc 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 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, showing actual location of project on premises.
Signature:
(owner, owner's agent, architect, contractor)
s ._ �_l';_lP_l J_� J_..l'J_.•l��.1:Li,:'J_.�_l'J:.._l ��.p.: "_l'J_•cl N.,J`�l,,.._l' s_l' ._C 1� .v..ki t t J_...).:Al"ivAs l_e_l' s A.:,AsQ ..Q,.. _C �_mti.At..2 i� e )�:,),._l J! !l,Aitia sC":!..� v*
THE NEW YORK BOARD OF FIRE UNDERWRITERS ''
BUREAU OF ELECTRICITY - ir,
I- NOVEMBER 1 E 111yASHINGTON AVE., SUITE 704, AL,RAN,.Y,, 120 146733
r
Date A�lica orf 1�7R99n�-f--6£31
�c p
THIS CERTIFIES THAT —�V fr
lb only the electrical equipment as described below and introduced by the applicant named on the above application n mber is in the premises of r;
-_11 NO.RT'HWINDS, 37 SUGARBUSH RD. , RUSSELL SMITH, QUEENSBURY, NY
it
j' OUT - '-
in the following location: ❑ Basement LI 1st FL ❑ 2nd Fl. Section Block Lot
was examined on and found to be in compliance with the National Electrical Code.. is
WI FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
IA' IA
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS Y
-, AMT. K.W.. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. 'AMT. AMPS. TRANS. col H.P. NO.OFMS FEET AMT. WATTS
:11•
.i ■-■ '
+ SERVICE DISCONNECT NO.OF S -- E R V I C E r=
1 ,y.
TER
--' AMT. AMP. TYPE EQUIP.E 1 0 2WMEI 3 0 3W 3 0'4W NO.OF CC COND. A.W G• NO.OF HI-LEG A.W.G. NO.OF NEUTRALS A.W G. e
PER 0 OF CC.COND. OF HI-LEG OF NEUTRAL
I•
IA
OTHER APPARATUS: ifi'
', 1 SET #4 CONDUCIERS FROM MCB TO MN-1 4
i>=
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„ck kg
Iyi
kr
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TODAYS MODERN HOMES 4 t, '�';;,Y �_ ;
K.: 54 ROUTEf, I
•I GANSEVOORT, IVY, 128 31 :,,F.� At,..•. S<, r+=F. • GENERAL MANAGER. r
1 ; ,,°l '.'Civ_ a,,:-.-...„,,,..... 2 9
1 ►-.' ►�+4-Or Per
r.
certificate must not be altered In any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
•,1 This
*5'07(1 4Y ti0 Y Y..Y 4-Y-0Y 4711 YiYY'0YY16 41-1 4'6 rie 4Y Y.`ti Y.Y;Fe 4Y 7..Y 4Y Y�Yi/VY,Y�YYsY 411 4YYY Y�Y Y Y Y�Y YiY� Y4Iii Y�Y YiY4TI46476 476 4Y 4i1 Y� Y�Y 4YY Y�Y Y� Y�Y 4761S
nnPY rnP RI I11 flIM(T IlFPARTAARKIT TI-IIC CfPY nr CFPTIFICATF RAI ICT mnT ❑C Al morn Inl Ar,ly 14AAIKIOD
0114:I y°INSPEGTION FORT 411.
MOBILE %. MODULAR ------
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804 ��
(518) 761-8256 7
ARRIVE: 1 DEPART: Qr2,_CINS .
DATE INSPEC REQUEST RECEIV /UV l�
AUD' !-2 q e
( � , /
NAME: ,' Sex. _ dam----VAI
LOCATION: o'-e 3 7 (OJ Slid
DATE: th7 & 15 PERMIT.#__k4
MOBILE HOME MODULAR HOME
FOOTINGS . FOUNDATION _ BACKFILL_ FRAMING
N/A , YES NO
1. foundation support, pier spacing /j ,
per manuf.2. anchoring per manuf. — / —
3. water line shut off
4. sewer line support @ 4 f-:t _ k. —
5. heating crossover dble 'ge) o grd. — / —
6. dryer vented outsi 1 e ..�.. _ _. y/ —
7. skirting ventilated . .... ... —
8. hot water relief valve sing o ide —
I.
9. deck, porches, steps, r•fling —
10. furnace/hot water opera ting / —
11. garage fire proofing ✓ - - .. ,
12. door closers / -
13. plumbing fixture — —
14. foundation insulatio (if appl.) — 1 _
15. smoke detectors 16. final electrical i _Ni.
17. variance required
18. data plate okay — �1
19. mobile HUD,.s, okay —
'J—1 l 1-1 'tLI
Model it(-A Ji t•-\"?O lam, cl Serial # `2)t D C`Z7 -i
Manufacturer
J?i,'-k-h ':;C) :LIAICIft-ML
Date of Manufacturer 9-Z3j"-91
OKAY TO ISSUE C/O YES
Comments: t=\;�' Xif .— e...., - r
Q N A) \1 ‘
i.-
GENERAL INSPECTION REPORT 41r
(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: PERMIT#
LOCATION: yr)C\ DATE :
TYPE OF STRUCTURE. s<D
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
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
Foundation/Dampproofing
Backfill Approval
Plumbing Under Slab
Plumbi Vent/Vents in Place
gh Plumbing A -A-a,
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R •
-
Ceiling R-
Duct work or piping in
unheated spaces R- - •
Proper Vent, Attic Vent_
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
' I 1 1 . 1 1 DEALER COPY
anufacturer's Name and Address HUD No.
U .Y. 486142 486143
MCILIM—EPIBUITAv PA
ant No. Model Designation Serial No. Date of Mfg.
•
—'S'�'� ' S5h2 �LAR 41 /21t0 O3-23- )
This manufactured home is designed to comply with the Federal Manufactured Home Construction and Safety Standard in force .
at the time of manufacture. Design Approval by Underwriters Laboratories, Inc.
story Installed Equipment Includes:
MODEL RATING OF FACTORY INSTALLED CIRCUIT EQUIPMENT
EQUIPMENT MANUFACTURER DESIGNATION (APPLIANCE NOT FACTORY INSTALLED) SERIAL NUMBER
ifort Heating 1 _Itqr r.gil IWC01 Iial / 1 141S980900613
3onditioning 2 1 _ / if 2 / •
king Range 3 GE JC81303PPAINB / 3 _AV105191P
-
t in Oven 4 / / / 4 / _
nter-top Cooking Unit 5 / / / 5 /
Aerator 6 O TRi[1 / 6 'DV8118.30
er Heater 7 MIS SCE 402F108,60 . / 7 F99123050.
:hes Washer 8 / / 2 11,511 8 /
hes Dryer 9 / / • 30A 230V ilk 9 /
masher 10 / / / 10 /
:d Waste 11 / / / 11 /
oke Detector 12 l _120V AC 1 12 - /
!place 13 mum& �'; 11 / 13 AC / eL-'3yZ9
14 I / / 14 /
Instructions for all work to be performed in the field are located in the kitchen drawer.
he maps in this box define the design loads for each geographical HOME CONSTRUCTED FOR It Zone I ❑ Zone II ❑ Zone III
rea. This manufactured home has been designed for the roof and This home has not been designed for the higher wind pressure and anchoring provisions required for
ocean/coastal areas and should not be located within 1500'of the coastline in Wind Zones II and III,unless
find load zones as checked: the home and its anchoring and foundation system have been designed for the increased requirements
specified for Exposure D in ANSI/ASCE 7-88.
North 40 PSF ❑South 20 PSF This home has Ehas not❑been equipped F(ac,f0( - C.t-
q pped with storm shutters or other protective coverings for windows
Middle 30 PSF ❑ Other PSF and exterior door openings.For homes designed to be located in Wind Zones II and III,which have not been
provided with shutters or equivalent covering devices,it is strongly recommended that the home be made
ROOF LOAD ready to be equipped with these devices in accordance with the method recommended in manufacturers
printed instructions. I
fri 'I.
:„:„, „. „,:,„
or
WIND LOAD
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wale 00 lin 1.1 5 q
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MANUFACTURERS :-;Z ........ ,...,.....:...:.:.:......r.:„.,..„,::
OV 0 I 1999
.:0 ..P.... ::7 .,54::5 0".. .....ONE::"." .... :'-'• ....oF alEENSBURY
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