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1986-380 CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK I. Date April 16 19 This is to certify that work requested to be done as shown by Permit No. 86-380 has been completed. This structure may be occupied as a Mobile Home Dwelling Location 41 Burch Road Robert Burch _ Owner By Order Town Board TOWN OF QUEENSBURY Building & Zoning Inspector A BUILDING PERMIT TOWN OF QUEENSBURY No. 86-380 WARREN COUNTY, NEW YORK t PERMISSION is hereby granted to Robert D. Burch OWNER of property located at Burch Road Street, Road or Ave. in the Town of Queensbury,To Construct or place a Mobile Home Dwelling 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 204 Broadway Fort Edward, New York 2. CONTRACTOR or BUILDER'S Name same CD 3. CONTRACTOR or BUILDER'S Address td 4. ARCHITECT'S Name CD 0 0 w 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) ( )Wood Frame ( 1 Masonry ( )Steel 1 7. PLANS and Specifications 1974 Hillcrest Mobile Home No. 12'x65' mobile home per plot plan and application submitted including sewage system — Per Var. 1093. 8. Proposed Use co Mobile Home Dwelling 0 0 CD $5.00 C/0 Paid $ 25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES FEb. 1 19 87 c (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.) pq Dated at the Town of Queensbury this 8th Day of of JUly 1g 86 SIGNED BY ma c:Y (..t< / for the Town of Queensbury Building and Zoning Inspector al • • • owno BUILDING & CODES DEPT, MODULAR / MOBILE HOME ACCEPTANCE DATA • NAME (Property owner) (1/410 ADDRESS 95 !Lt /J wv gar t Location of property. upon which home is placed BUILDING PERMIT NO. 1C/o�3'0. State of New York Division of Housing and .Community Renewal • INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE COUNCIL/ DHCR 1 . INSIGNIA SERIAL NUMBER ' /q1?-c 3 6 2 . 'NAME OF MANUFACTURER /YA,./41.4-7, 3. PLAN APPROVAL NUMBER 4. MODEL OR COMPONENT DESIGNATION 5. MANUFACTURER'S SERIAL NUMBER • dan -r6/ I 6 . DATE OF. MANUFACTURE 196q . . All of the above information is to be found on a plate or sticker which should be affixed to the Mobile/ Modular Home. '01976:71/ 4;::) . Da e . Building Inspector COMMENTS: • • • • • • Form MHA 3/87 and/vl • TO BE COMPLETED BY BLDG. DEPT. • // Application No. OF QUEENS >URY awn of Queeniur y Permit Issued 19 �� � � � jj �(1 `�,l BUILDING and ZONING DEPARTMENT Permit Expires 19 11 v' -� 4 Bay.and Haviland Road, R.D. 1 Box 98 Zoning Designation �t �d Oueensbury, New York 12801 Variance No.• /(�q.3 2JUK ii ,�.- (¢ Site Plan Review o. A -� _Ae,6 n4.l .M. la� _ APPLICATION FOR App - y: • ?1819pg111J2)1_1C2,.)R1M • MOBILE HOME c/o /Pc c- . EUILDING AND ZONING PERMIT - .-c-plc (,vac * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *;:* • A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. ANSWER ALL OF THE FOLLOWING. The undersigned hereby applies for a Building Permit to do the following work which will be done in accordance with the description, plans and specifications submitted, and such special conditions as may be indicated on the Permit. • C)The owner of this property is: 1.--ir.cSL . / �� ( � l ,, . P.O. Address 5-4^ 8(ItC h `/� r Tel. Property Location: /3 U t (I, h R . Tax Map No. ' / / Street number. or building lot_ Subdivision name (if applicable) ------ _ THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS: ,f b-W� YL P. 8orcA • Name P.O. Address Tel. No. • Name of .Installer Address Tel. Name of plumber Address Tel. Name of mason • Address Tel. MOBILE HOME INFORMATION: * ZONING INFORMATION: New Home Placement y 1 0 • * A PLOT PLAN MUST BE PREPARED AND SUBMITTED, -* drawn reasonably to scale and attached hereto, Replacing existing Home ' il) 0 * showing clearly and distinctly all buildings, Size of new Home / ft X G$ ft . . * . whether existing .or proposed and indicate all *• set-back dimensions from property lines. Give Single wide • V Double wide * street and number or lot number and indicate * whether interior or corner lot. Show location No. of rooms (excluding baths) j * of water supply and location and configuration No. of bedrooms .3 * of septic disposal area. * No. of bathrooms / * COMPLETE INFORMATION REQUIRED BELOW. Fireplace? Wood stove? * Size of property r 6 Q ft X 3 ©C) ft. Foundation style and size: * Existing building(s) Size ft x ft. / Piers- No.of/o � Size-/��f^t; x / 6 -/ -f- : * Existing building(s) Use * Depth below grade 4,/. ft. / * Proposed building, distance from property line I.—FOUNDATION - Fobt±n• . ize 2 " X ‘,/ ct' * �" •* Front yard COO ft Rear yard Z2 ft Wall material - * Side yards ( ft and ZED ft Wall thic ess fight * If on corner, setback from side street �f Tota epth be51 grade ft. * OCCUPANCY INFORMATION / * Grade to Home floor level ft. * PRIMARY BUILDING - * * * * * * * * *. * * * * * * * * * * * * One family dwelling ,---Two family dwelling Proposed date of placement ? / I / ' * Multiple dwelling / Number of units * Permanent occupancy Aprox. Value. of Home $ 5 00 0 - * Transient occupancy . Water supply - i► Municipal * Business * Industrial Septic Permit required?' '/ -S * Other • * If addition, what will use be? * FURTHER INFORMATION REQUESTED * ACCESSORY BUILDING- ON THE REVERSE SIDE OF THIS' SHEET .* • Detached garage/one car/ two car/ car * Attached garage/one car/ two car/ car • * ' Private storage building * Other * Form MHP 5/86 and-vl APPLICATION FOR MOBILE HOME PERMIT, (CONTINUED) State of New York Division of Housing and Community Renewal INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE 1 . INSIGNIA SERIAL NUMBER 2 . NAME OF MANUFACTURER I4 i CL C i2L—S T 3 . PLAN .APPROVAL NUMBER ' 4 , MODEL OR COMPONENT DESIGNATION 5 . MANUFACTURER ' S SERIAL NUMBER 6 . DATE OF MANUFACTURE I q ? • 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. * 4 4 * 4 * * * * 4 * * * * * * * * * * * * * * 4 * 4 * * * * * * ** * * 4 Town of Q Warren AFFIDAVIT STATE OF NEW YORK County of Warren 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 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 not, and that such work is authorized by the owner. • Signature X- Owner, owner's agent,arcnitect,contractor • * * * * * * * * * .* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * SPECIAL CONDITIONS OF THE PERMIT: Uk we; -e 1-0 re_ V-) CL 1AJ McA4 • • BY - flown of (teenil ury APPLI!I , ON FOR SEPTIC DISPOSAL PERMIT . • BUILDING and ZONING DEPARTMENT T ow.'� ',LiEENSB RY Bay and Haviland Road, R.D. 1 Box 98 �jj Queensbury, New York 12801 /i i� tJ 5 11 ,U y DATE 0%/ LOCATION OF •PROPERTY FOR I NSTALLAT I-ON , i f* r 141516'� PIC 7i819110P112)1' ee OWNER' S NAME 7RobkJ kC ,�'� ADDRESS c20 / r® /-/1< Edb.G// d /!/=V. TEL- 77 7`”/7 I INSTALLER' S NAME (3 P- / ,//7 7)9qf') •TEL Number of bedrooms(residential only) Total daily flow(compute @ .150 gal per bedroom) 115-0 Topography: Flat - Rolling - Steep slope - (circle one) % of slope - Soil nature: Sand - Loam - Clay - Other Depth '• ft. Ground' water -At what Bed-rock or impervious material - At what Percolation test Not ' er moire Required - -Rate min-inch. Domestic water supply - Municipal -- Well - Other . Separation - Watersupply(if well) from Septic absorption ft. Proposed System: Septic tank f• o o gal. ( Minimun size, 1000 gal. ) Tile Field - Each trench ft. Total system legnth ' ft. Seepage pit(s) Number of . Size each - 6 ft X .b ft r 2) Size of stone to be used # 4t3' Depth or thickness ' ft. IMPORTANT1 ! On a separate piece of paper, submit a diagram of the proposed system with all dimensions shown; including distance from any structure , distance from property l•ines• and from ANY DOMESTIC WATER SUPPLY or shore-line of lake, stream,pond or wet-lands. Include all dimensions of the system, itself. * * * * * * * • * * * * * * * * * * * * * * . * * * * * * * * * * * * * * * * I _have read the regulations on the reverse side of this sheet and agree to abide by these and all requirements of The Town of Queensbury Sanitary Sewage Disposal Ordinance. Signature ofresponsible person4/44_,y,piftg :/7 Date 6I (R [ p IO 05/86 and/vl • • . Section II Septic System Inspections: • A. All applicationB for septid , system installation, alteration or repair, as required by the Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Buildina Department at least • 24 hours before start of construction and shall include a plot plan showing: • 1) the proposed location of the system 2) location and distance to -lot lines 3) location and distance to structures 4) location and distance to any water supply 5) size and dimensions of all tanks, distribution . boxes, tile fields and/or drywells B. No system shall be covered before inspection and ' approval by the Building Inspector. Failure to • comply with this requirement may result in the uncovering of the- system by the installer and a fine of up. to $250.00. • C. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan. at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an,,approved system, a new proposal must be submitted , to. the Queensbury Building Department before further construction. Jown of Queeniur1 BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York-12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION yam& , a fe4- i Date';/ / ��` Permit No. ,�(0 3 gb * * *��f * * * * * * * * * * * * * * * * * * * L. ✓ = APPROVED - YES ,/ NO Footing/Pier Forms Foundation Waterproofing Backfill Framing roofing a c V5lding • 17F Masonry Veneer )( Rough Plumbing / L.lief Valves \ Porches (,Finished Floors`, 0,k LI-nterior Trim \ OE \.6airs & Railings \� Cellar Drain Tile . Concrete Floors U6lbg. Fixtures ,/ A k -ar. Fireproofing Nf4 L>Soor Closers / IAMoke Detectors p, Chimney INSULATION: Foundation Floors Walls clin FINALg ELECTRICAL INSPECTION /"n DRIVEWAY APPROVAL L4inal Building Survey . 1,,11P&L /f001iC Next scheduled inspection (call when ready) Remarks- F/ oA WO 604 Building Inspector 6/86 and-vl 11; 5 Z1( Ckn`o;�9,44)m/ -own of Queenitu,.cy BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 • SEPTIC DISPOSAL SYSTEM INSPECTION '' tico.3itL— NAME 1 �.:c� C / .y6" LOCATION Ai&a go- DATE geh-/ �C PERMIT NO. K(0 - ,- ,;U SOIL TYPE -(San� - Loam - Clay - Percolation Y'�st Required? YES Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field, total length Length of each trench Depth of trenches Size of gravel SEEPAGE PITS{Number of) _ Size- ( ft. X C, ft. Gravel size ' PIPING: Si a Type Bldg. to tank Ye) Tank to dist. box Dist. box to field/ 't Openings sealed? YES' NO Partial LOCATION/SEPARATIONS: Foundation to tank 0 ft. Foundation to absorption ((f ft. Absorption to lot line L} ft— Separation of pits ?eft. LOCATION STEM ON PROPERTY(circle one) Front ear Left side - Right side - COMMEN . /\, F RN r ti\, 4 E4 Y r� `\ r / /• SYSTEM USE APPROVED YES NO ,� Zi.e- Bui ing nspector • 01/86 and vl • Jocun o� Queeniilury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME rTh� (: 12 2: Lfi LOCATION Date 7/7- / Permit No. n, - 3 ?C1 ` ✓ = APr ROV - YES / NO Footing/Pier Forms S Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext. Porches Finished Floors \ V Interior Trim \ Stairs & Railings /k. Cellar Drain Tile Concrete Floors Plbg. Fixtures Gar.. Fireproofing Door Closers Smoke Detectors Chimney INSULATION: Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION Final Building Survey • Next scheduled Inspection(call when ready) Remarks- - c Building Inspector 6/86 and-vl . . i ,.. ',••••-1-,..' 43 '.:-...,_ r 1-1), ' • . 1.. 1-' ,. ,. , •• ••'' -.c? i \‘',.,„ . '•• ,,,,...-- I f • / — 1- c- .- / 0 r • ,, - 4(..,-/ i,„,., / _of -.; 11:--1-•-- L '' 12 .... -.. ...,.-___...... C--! -) ,..; - (1 • ..- ,.......tr...•-••• ______ 1..H 2 • ,..-. r Z ,•• ,. ,-, .? 4••• '''_7' "., i' ri ' .• , j ti .,4 't . i •--L. ". ,_- 11 r. ri • er.) 1 :514'l 1ill 0 _, c ..... ..„..... .., , . ._..... .1 .-- -.,,i, -.3 ‘ •t !, , . . .,.......r............... /. - • - . ,....„.,,..,. ,.I. .._............, I .. ,. , ..._. ,_ )...., ,--• . --,.. -,-/t) • -(11 n /-- / O. •'.-----, LI, , • ---. , ; D-/- , . 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