97-052 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date June 4• 19 _97
M
This is to certify that work requested to be done as shown by Permit No. 97052
has been completed.
14 FT. BY 72 PT. SINGLE WIDE MOBILE Fl.• ME
This structure may be occupied as a
LOT 62 LU a E R NEi RD.
Location
Owner SERRANO, PABLO
TAX HAP NO. .t 3 . q_2_11 . By Order Town Board
TOWN OF QUE SB RN'
Vag,
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Director of Bldg. be Code Enforcement
BUILDING PERMIT •
VALUE $ 0 TOWN OF QUEENSBURY •
No. 97052
TAX MAP NO. 93. —2-11 . 1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to SERRANO. PART.n
OWNER of property located at
LOT 62 LUZERNE RD_ Street, Road or Ave.
in the Town of Queensbury,To Construct or place a 1 4 FT. -BY 72 FT. SINGLE WIDE M.OB.LL 1 HOM
at the above location in accordance to application together with plot plans and other information ereto hied an
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNERS Address is
OWNER OF MOBILE HOME LOT 62, LUZERNE ROAD HOMESTEAD VILLAGE MN
QUEENSBURY, NEW YORK 12804
2. CONTRACTOR or BUILDERS Name
GLENS FALLS MOBILE HOMES , INC.
3. CONTRACTOR or BUILDERS Address
39 SARATOGA ROAD
GANSEVOORT, NY
4. ARCHITECTS Name
NEW YORK BOARD
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
MOB , HOME
( 1 Wood Frame ( 1 Masonry ( I Steel
7. PLANS and Specifications
14 FT. NSY 72 FT. SINGLE WIDE MOBILE HOME (REPLACEMENT HOME)
AS PER PLOT PLAN AND SPFrIFICATIONS
8. Proposed Use
14 FT. BY 72 FT. SINGLE WIDE MOBILE HOME
$ 35 PERMIT FEE PAID —THIS PERMIT EXPIRES March 3 .19 99
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 3 Day of March 19 97
SIGNED BY
for the Town of Queensbury
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Bui ding and toning Inspector
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TOWN41111k :. .
•g.41 I I I P I a I 0 I : . • OF Q ULENSI3 UI? FEB 241997
REVIEWED BY: -� ('1-i -
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FEE PAID: $ a:<;--:�
' PERMIT NO. q —ô7
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 is:
Pj5(61.-P'4
P.O. Address: 10-10 &‘, Phone Number 79.2.211bcp
Property Location - Jt„9 !rill/e U, 4- Tax Map No. / /
NAME OF APPLICANT: ()i ( ', Z -0
Address of Applicant: Att (,022-- 'N--(AAA.9..1 .0...4 V `
All applicants spaces on this application MUST be completed and the
signature of the applicant MUST appear on the reverse side of this application.
PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES:
MOBILE -HOME INFORMATION 46 /0`'4 APPROX
IMATE VALUE OF HOME. $ 200;
New Home Yes No
SON NG INFORMATION:
Replacement Ilom• - ► o 7 `iQO�SSi e of Property: ft x ft
Size of mobile home ILI ftx t
. / Existing Buildings:
Singlewide f/ Doublewide
No. of rooms (exclude baths) Proposed building-dist ce from property line:
Front Yard ft Rear Yard ft.
No. bedrooms 3 • Side Yards ft and ft.
No. of bathrooms Occupancy Informatio
Primary dwelling: es No
Fireplace Woodstove
Accessory Building( ) :
Foundation style and size: Detached garage o ar /two car car)
,
Attached garag r r/two car car)
Piers-No. of Sze ft x ft Storage builds g —
Otirer
Deph b go de ft
Foundatio- Fo ti g s e " x
!' * * * * * * * * * * * * * * * * *
Proposed placement:
Wall mate i
Wall thickness " Height " ' Water Supply: Well Municipal
Total depth below grade ft. Septic permit required? t
Grade to home floor level ft.
FURTHER INFORMATION REQUESTED ON THE REVERSE SIDE OF THIS SHEET
NAME OF INSTALLER/MOBILE HOME DEALER: `-� 1/)__ Mb U
ADDRESS/PHONE NUMBER Or:0 '79 Z'2st)
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STATE OF NEW YORK DIVISION OF HOUSING AND COMMUNITY RENEWAL
INSIGNIA OF APPROVAL OF THE BUILDING CODE
1. Insignia serial number TP4FtL 22A61SC.
2. Name of Manufacturer ee Lej
3. Plan Approval Number
4. Model or Component Designation
5. Date of Manufacture 159D
All the above information is to be found on a plate or sticker which
should be affixed to the Mobile Home. Complete above with that information.
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Town of Queensbury State of New York
County of Warren
AFFIDAVIT
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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 bq. 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 speciIIed or not, and that such work i s authorized by the owner.
Signature W
Owner, owner' s agent, architect,
con tractor
SPECIAL CONDITIONS OF . PERMIT:
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By
Code Enforcement 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, 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 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)
SERRANO PABLO
BLDG. PERMIT NO. 97-052
APPLICATION FOR A TEMPORARY CERTIFICATE OF OCCUPANCY
A TEMPORARY CERTIFICATE OF OCCUPANCY is hereby requested for the property
located at; Lot 62 Homestead village mobile Home Park
for the following uses: Mobile Home
.11_9`� 1174/b
DATE WIGNATURE OF APPLICANT
TEMPORARY CERTIFICATE OF OCCUPANCY
The TE_M_P_Obi.AR.Y._CERTIEICATE_OF_OCCUPANCY is hereby O; PROVED __
( )DISAPP'ROVED
with the following conditions: Certificate of Occupancy to be issued
upon completion of: Skirting, Anchoring, Dryer Vent.
Hot Water Relief Pipe
TEMPORARY CERTIFICATE OF OCCUPANCY FE • 10.00 DEPOS T: )$100.00
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received on 3 of tit- 7
Date of Issuance Director of Bldg. & C de Enforcement
THIS TEMPORARY CERTIFICATE OF OCCUPANCY EXPIRES _ 91) DAYS
FROM THE DATE OF ISSUANCE.
NOTE: This Certificate is NOT VALID unless signed by the Director of Bldg. & Code
Enforcement or his designee.
FINAL INSPECTION REPORT
----MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road •
Queensbury, NY 12804
(518) 761-8256 .
IN*"'•. f
DATE INSPECTION REQUEST RECEIVE:
NAME:
LOCATION: Co•
DATE: • PERMIT ti
iffiffif�
M®TILE HOME MODULAR HOME
FOOTINGS _ FOUNDATION _ BACKFILL FRAMING
N/A YES NO
1. foundation suppo , pie spac g
per manuf.
2. anchoring per man .'.
3. water line shut off ...
4. sewer line support @ 4 feet
5. heating crossover dblewide) off grd. — V —
6. dryer vented outside , /7. skirting ventilated _ v
8. hot water relief valve piping outside
9. deck, porches, steps, railing
10. furnace/hot water operating
11. garage fire proofing
12. door 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:
Off ` \ 1)` "
,r fi.N, TOWN OF QUEENSBURY
'' '>z BUILDING & CODE ENFORCEMENT
s :� 742 BAY ROAD
' + QUEENSBURY NY 12804
q ( (518) 761-8256
ARRIVE: //Jae' DEPART: INSP:
FINAL INSPECTION REPORT - RESIDENTIAL
DATE INSPECTION REQUEST RECEIVED• --A1`�C��
NAME \C-Gk"X1.0 " l 1
LOCATION l 0
DATE 3^(;1-1 - 1 - PERMIT # l ~LJ J
TYPE OF STRUCTURE m QA")! f4n
FOOTINGS _ FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING _ SEPTIC INSULATION _
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT/B VENT H IGHT
PLUMBING VENT
ROOFING
EXTERIOR FINISH
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES
FURNACE/HOT WATER OPERATING
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED ____
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS __—
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL 3 Jcy A
SITE PLAN/VARIANCE REQ.
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C/C
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03/03/1997 09:21 5187982803 ELE:',S FALLS M M HOMS PAGE 03
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Application
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Zonin •Administrator
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