97-085 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date May 14 19 97
31q — 17
F-7.3
This is to certify that work requested to be done as shown by Permit No.
I
has been completed.
MOBILE HOME
This structure may be occupied as a
43 C'fJNTRAL AVENUE ` i
Location
RICE , FLORENCl
Owner
1TAX HAP NO. 127 . -5-10By Order Town Board
TOWN OF QUEENSBURY
I
Director of Bldg. & Code Enforcement
BUILDING PERMIT
VALUE $ 40000TOWN OF QUEENSBURY No. 9701R�i
TAX MAP NO. 127 . —5-10 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to RICE, FLORENCE
OWNER of property located at INDIANA AVE.• Street, Road or Ave.
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 Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
INDIANA AVENUE
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
KENDRICK, BRIAN
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
COMMONWEALTH ELECTRICAL AGENCY
5. ARCHITECT'S Address
PO BOX 706
HAGUE, NY 12836
6. TYPE of Construction—(Please indicate by X)
MOBILE HOME
( )Wood Frame ( 1 Masonry ( )Steel ( )
7. PLANS and Specifications
1051N°SQ FT MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
MOBILE HOME
$ 66 PERMIT FEE PAID —THIS PERMIT EXPIRES March 31 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 31 Day of March 19 97
SIGNED BY �.W—4Y for the Town of Queensbury
Building and Zoning Inspector
• i 3
TOWN TOWN OF QUEENSl3URY
REVIEWED BY: (1)(6
FEE PAID: $
. G
PERMIT NO.
APPLICATION FOR PERMIT /
MOBILE DOME OR MODULAR 1
A BUILDING PERMIT MUST BE OBTAINED BEFORE PLACEMENT OF MOBIL HOME.
NO INSPECTIONS WILL BE MADE UNTIL A VALID BUILDING PERMIT HAS BEEN ISSUED.
The owner of this property i s: rGOrej„cE_ 1/ L l GE •
P.O. Address: / O ( p- ,j-,,_) fj)` 6a(8' Phone Number
Property Locationaj,� C�,�,Tz,q-C ,t om/ a4 Tax Map No. I27/$ / ) 0
NAME OF APPLICANT: FL 0 ,K' G- I C_,
Address of Applicant: /0 f-�!- .-,1,./ f„ 61 -i'y.. � ..- '` '- f,
MAR 2
01997--
All applicants spaces on 'this application MUST be comple ed3tr,an'd ..the_ `:;4`:_ `l
signature of the applicant MUST appear on the reverse side of this apipl agiia
PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGAR S BUILUIN CODES:
r , 4 1 ic.k
s ,
MOBILE HOME INFORMATION
��/ 1�,
APPROXIMATE VALUE OF HOME: $ / i 0 o b
New Horne Yes No ZONING INFORMATION:
Replacement Home Yes No' Size of Property: 9C) ft x itY0 ft
Size of mobile home2.Li ftxLyft (Box Existing Buildings: /IJgg,tIi
• Singlewide Doublewide ,
No. of rooms (exclude baths) Proposed building-distance from property line:
Front Yard .5/ ft Rear Yard /„.`r ft.
No. bedrooms Side Yards _30' ft and 2_(, ft.
No. of bathrooms Occupancy Informatio •
Primary dwelling: No
Fireplace NO Woodstove tv) 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 •ft Storage building
Other
• I, Depth below grade ft
e. �SY 4.. ,� �,v IA.k ILI,s .t. * * * * * * ,k * * *. * *
Foundation-Footing size____". x !' Y �`,AIazIV-Proposed date of placement:
Wall material l'x/z'' �,,� ��
Wall thickness " Height ' " Water Supply: Well Municipal Y.
Total depth below grade ' ft: ' Septic permit required? )/ J---
Grade to home floor. level ft.
FURTHER INFORMATION REQUESTED ON THE REVERSE SIDE OF THIS SHEET
NAME OF INSTALLER/MOBILE HOME DEALER: l< (..11/4) twee/ v4),
ADDRESS/PHONE NUMBER (1k1D 2) 754 4-6-2 81 �/--
cif 7 — a3-9 •
STATE OF NEW YORK DIVISION OF HOUSING AND COMMUNITY RENEWAL
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
1. Insignia serial, number 07 cc/2 E ` _f ta
2. Name of Manufacturer Tk y Li N E
3. Plan Approval Number
4. Model or Component Designation
5. Date of Manufacture 19 ?2
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.
•
•
Town of Queensbury State 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 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 specified or not, and that such work is authorized by the owner.
Signature
Owner, owner' s agent, architect,
contractor
•
SPECIAL CONDITIONS OF PERMIT:
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)
Application for SEPTIC DISPOSAL PERMIT
r
Town of Queensbury Permit No. `I Dept. of Community Development
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
Location of property for installation: LC`J
Property Owner's Name: fto r AJ C•e___ R /GiE- MAR 2 01997
Property Own is Mailing Address: 0 ���
Installer's Name: G'r i Phone # 7 9 Z - 71 r 7
Number of bedrooms (if residential): 0 Total daily flow: "45---0
(residential - compute @ 150 gal./bdrm.)
Topography: (f1at, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not r uir , required [rate min. per inch]
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank: 100D gallon (minimum size: 1,000 gaL)
Tile field: each trench re feet / Total system length: 0 feet
Seepage pit(s): number of /A I size each: ft. by ft.
Size of stone to be used: # 2 / depth or thic'sness / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
y 1
Alarm system and associated electrical work to be inspected by a certiffed agency.
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 res : to •pplication and agree to abide by these aid all requirements of the Town of
Queensbury Ssnitary Sewage ':..sal =. /
Signature of responsible person: ✓ Date: J ' ` /`—/L2
II
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lr
THE NEW YORK BOARD OF FIRE UNDERWRITERS l tv,u 1
0 ?"''1( :i1;,'1 BUREAU OF ELECTRICITY ;y
111 WASHINGTON AVE., SUITE 704, ALBANY, NY 12210 y
Date - 1 F.1: Application No.on file 1 1.`;I.I t¢"•3'i 19.i !-; .1.4" <:e:'; :r
i THIS CERTIFIES THAT IT
f only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of �Y
I.
h'itiin ii-'s1li.ltt'; i31i.1':i)- f, ` :i�.111-4T4.,i.113,1).l.;o"�NA, pi.,lbil'1;1-31:il.1l u� 1 ( he
s. 'Y.R1 U5 r
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in the folk ing location; ❑ Basement Ell Fl. ❑ 2nd Fl. {_r�1'1' Section Block Lotto
was examined on i,7F':'i• I 3. 9.5i'4 i and found to be in compliance with the National Electrical Code.
li i�' u
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS ;C
RECEPTACLES SWITCHES
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. T
i 'i
' DRYERS 'I FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS r
Y
K.WJI OIL
ill
H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET SYSTEMS
AMT. WATTS iy
I
ff :
�
-; . SERVICE DISCONNECT NO.OF S E R V I C E 'r
1�,. AMT. AMP. TYPE METER-
I S 2W 1,a 3W 3.1 3W 3.M 4W NO. PEC.COND. OF CC.COND. NO.OF HI-LEG A.OF HI-LEG G. NO.OF NEUTRALS OF NEUT W.RAL Y
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OTHER APPARATUS: '•
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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. :
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COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement -." , 31)
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
`� �/ JP6------
DATEARRIV cE j • ��DEPART: �� .INSP:INSPECTION REQUEST RECEIVED:
NAME: 4 l ove)y1c;,o , Ri-c32
LOCATION: ( 3 yv-\-m_P- 7
DATE: _ J PERMIT# 9 / v
k5
MOBILE HOME MOXNJLA HOME
FOOTINGS FOU ':!ATION _ BACKFILL_ FRAMING
N/A , YES NO
1. foundation support, p'.= spac' g —
per manuf. _ /2. ancho ' r manuf. . ..
3.—- 'a er line shut off
4. sewer line support @ 4 feet
5. heating crossover (dblewide) off grd. I _
0 dryer vented outside _ /
7. skirting ventilated _ �f/'
i8. hot water relief valve piping outside _ ‘,/,...-
v9. deck, porches, steps, railing _
10. furnace/hot water operating
r11. garage fire proofing _ —
12. door closers _„, _
/13. plumbing fixture —
tL
14. foundation insulation (if appl.) _ ✓,
I�smoke detectors _ —
16. final electrical — 7 —
17. variance required — _ —
18. data plate okay — _77
19. mobile HUD seal okay �_/ (]
Model # ‘3 Co/CTI Serial # (1p III`VZ5'76
Manufacturer
Date of Manufacturer ('it q I
OKAY TO ISSUE CIO YES NO
Comments:
FINAL INSPECTION REPORT
MOBILE / MOOULAR ,®:, NJ\
Town of Queensbury
Building & Code Enforcement .
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE:`lJ°tC DEPART:%C3 1i iNS fi•
DATE INSPECTION REQUEST RECE D: /
NAME: 1' -O .EE13 CE C•�
n! P
LOCATION: ll E -II /16'Y
DATE: 5 Il ClaPERMIT#C11' J
MOBILE HO � E MOD JLAIt HOME
FOOTINGS I47240
DTION��/ BA� KFILL_ FRAMING
h if N/A , YES NO
1. foundation support, pier spacing Z____
per manuf. \ I.... _ `
2. anchoring per in — V —
3. water line shut off 4. _ —
4. sewer line support`,`@ 4 feet/ — /
5. heating crossover (dblewide.) off grd. — •i/ —
6. dryer vented outsid
7. skirting ventilated ! _ — -,
8. hot water relief valvI pipipg outside — i✓
9. deck, porches, steps,\railing ....t — — '
10. furnace/hot water operating — _C
11. garage fire proofing ..`',,y / — —
12. door closers ✓ —
77,
13. plumbing fixture ,' — /
14. foundation insulation if a pl.) — --L
15. smoke detectors I \, —
16. final electrical / \,/ ____.----\7
17. variance required ',`1 -,( s/7/
—
18. data plate okay 1 — —
19. mobile HUD seal o y —
Model # Sefial #
Manufacturer "v
Date of Manufacture
OKAY TO ISS E C/O YES NO
Comments:
71 D E jE T0i VkiN.5 00.IS—Cibt4 %,
'T- te.r t riDF
\ cL FOB.
i
glilla
. \ \ RR)
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
N ame
c\ ----Nce,,,,,g--‘7 Q) c:_k,,. ,„,
Location ( 1'CY\C1 Q'°
Dater17Permit # ` O95
SOIL TY Militt0Li l ay-
IV
Results of Per :. ation Test-
(if applicab R.te-Minute/Inch
TYPE OF SY.•'End:
ABSORPT i', FIELD: Total Length 'Z,D
Length of each trench 0c1(c-3,5T,r
Depth of trenches Z
Size of stone . 7
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank / l
Tank to Dist. Box _lam_
Dist. Box to Field/Pit Le► r
Openings Sealed? s No Partial
LOCATION/SEPARATIONS:
xpk(3 F i-air to Tank H feet
Fou d-a-t4-gR--to Absorption ,. feet
Separation of Pits — feet
Conforms as per Plot P1 an —YsNo
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Fro - ear - Left Side - Right Side
iddl Fron - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: Y
Arri v;< a: s'-:-`s
Dep rted: ' ► :1T
e :ulding Ifpector
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR1 DEPAR'0400
REQUEST FO NSPECTION RECEIVED: r rt
NAME \ C 2_, YA 6
LOCATION
DATE p49- 1Li -97 PERMIT 0 q7_ 0 R
TYPE OF STRUCTURE: .5\9;)-e- NiY
RECHE7. _ APPROVED
N/A YESS/' NO
OTINGS/PIERS V
v ONOLITHIC POUR FORM V ,
YY/ REINFORCEMENT IN PLACE Z � 9,.* , / �/
iW t-
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION F OM FREEZING
FOR 48 HOURS FOLLOWING THE CE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS RP E ON SITE
FOUNDATION/WALLPOUR _
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING: '
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
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-
(518) 761-8256
TOWN OF.QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., .QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR ICDEPART (f-
REQUEST FOR INSPECTION RECEIVED:
NAME - C
LOCATION 001 KA Pt0E
DATE Litz._.\cc7 PERMIT 0 97-c %5
TYPE OF STRUCTURE: �R11 OOMF
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESP NS BLE FOR
PROVIDING PROTE TION FROM REEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLA _
ROUGH PLUMBING _
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HE''ERS
BRACING/BRIDG NG
JOIST HANGER
JACK POSTS/ ' 'IN BEAM
AIR INFILTRATION BA'RIER
HEATING ROUGH-IN
INSULATION:
FOUNDATION WA LS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS
R-
WALLS R-
CEILING R-
DUCT WORK 0r' PIPING IN
UNHEATED SP'CES R-
03/31/97 21:57 FAX 518 747.0885 KSnBsbrook Inc. IiI.1001
•
.:i 474f agela4 RD+l2 Box 557E
� • Hartman Rd.
✓w//1P.6 Hudson Falls,NY 12839
by Brian Kendrick (518)787"4259 -
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TOWN OF Qu EE. L.1, ':_:, rt u RI( ro
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BUILDING DEpT
Al' . ,
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' REVIEWED BY __/.4dIKA....' 4raf
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• DATE Aginfri- IF trb45 1
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