1986-445 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19 _
This is to certify that work requested to be done as shown by Permit No. 86-445
has been completed.
This structure may occupied as a
Mobile Home Dwelling
11
Location Michigan Avenue
Owner
Katie Springer
By Order Town Board
TOWN OF QUEENSBURY
, .
Building & Zoning Inspector
, 1
BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-445
3 / ' WARREN COUNTY, NEW YORK y \
PERMISSION is hereby granted to Katie Springer
OWNER of property located at Lk\ Michigan Ave. Street, Road or Ave.
w
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 cn
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
0
1. OWNER'S Address is 24 Jerome Ave.
rl
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Rainbow Homes
3. CONTRACTOR or BUILDER'S Address #3 Route 9 H.
Gansevoort, New York
o�
4. ARCHITECT'S Name
Cj
0
5. ARCHITECT'S Address 'rt
r•l
w
H
m
6. TYPE of Construction—(Please indicate by X)
( ) Wood Frame ( I Masonry ( ) Steel ( )
7. PLANS and Specifications
No. 1985 Imperial Mobile Home Serial Number 85640 including septic system
per plot plan and application submitted.
8. Proposed Use
MobileHome Dwelling
5 G'/z7. lohAL
$ 25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES Feb. 1 19 87
(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 28th Day of ^ July 19 87
SIGNED BY �, for the Town of Queensbury
Building and Zoning Inspector
1
TO BE COMPLETED BY BLDG. DEPT.
�] OWN OF QUEENSBURY
/uwn o� QuQ¢n��ur� Application No.
Permit Issued 19 ; ':::) E a la
BUILDING-And-ZONING DEPARTMENT' ........... .. Permit •Expires 19
Bay.and Haviland.Road, R.D. 1 Box 98 Zoning Designation JUL 2 3196
Oueensbury, New York 12801 Variance No.,
-Site Plan Review No. RM.I a. 7 - y 7IfIgPRI4MMIMf 1. 1s
APPL I CATION FOR Approved by:
MOBILE HOME (‘)-kl/(3.4,4
.BUILDING AND ZONING PERMIT -
* * * * * * * * * * * * * * * * * * * * * * * * * * * * e * * * * * * « * *::•
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 arid specifications submitted, and such
special conditions as may be indicated on the Permit.
The owner of this propertyro is: /�
P.O. Address a•y �,/,.Q J�pyyyI, (i, p ./�..)/, a_../.l� Tel.179,-?-0 59
Q
Property Location: m ) / � .4.4/0 ( .0Tax Map No. /a 7/ er/
•
Street number or b Ale
lot number
Subdivision name (if applicable)
• THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
. Name P.O. Address Tel. No.
Name of .Installer�,syJ ,J7y1) � ti idress � /y2Q f�� /7.,/. Tel. 7 93-vs/ a o�
Name of plumber " ' Address J Tel.
Name of mason Address Tel.
•
MOBILE HOME INFORMATION: * ZONING INFORMATION:
New Home Placement 14 ••'* A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
--" drawn reasonably to scale and attached hereto,
Replacing existing Hom 4 ,•. * showing clearly and distinctly all buildings,
Size of new Home ft X ft":.-- : * whether existing .or proposed and indicate all
,y...- �'`, * set-back dimensions from property lines. Give
Single wide Double •wide * .street and number or lot number and indicate
•
•
* whether interior or corner lot. Show location
No. of rooms (excluding baths) ^y
* of water supply and location and configuration
No. of bedrooms * of septic disposal area.
No. of bathrooms dt /'f// *
* COMPLETE INFORMATION REQUIRED BELOW.
Fireplace? Wood stove? * Size of property . / )t ft X /f ft.
Foundation style and size: * Existing building(s) Size ft X • ft.
t i * •
ILO"
Piers- No.of Size- . ft x 2-`l ft. * Existing building(s) Use
Depth below grade ft.
* Proposed building, distance from property line
FOUNDATION _ Footing .size " X rf4
* Front y: d </(® ft Rear yard 412a < t
Wall material
Wall thickness" Height ft. ` i' e t ft
Total depth below grade ft. r .Y M"""o,:o. •
Grade to Home floor level • ft. * PR RY .BUILDING
* * * * * * * * * * * * * * * * * * * * J One family dwelling
/ * Two family dwelling
Proposed date of placement q-//S /r(D * Multiple dwelling / Number of units
f Permanent occupancy
Aprox.• •Value, of Home- ,$ QQO, Qo * Transient occupancy
Water supply - Well Munici•a_ _, B i .
Septic Permit required? !
l use be?
•
FURTHER INFORMATION REQUESTED' . * ACCESSORY BUILDING-
ON THE REVERSE SIDE OF THIS SHEET.* • Detached garage/one car/ two car/ ' ' car
* ttached 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
I . INSIGNIA SERIAL NUMBER A1/
2 . NAME OF MANUFACTURER
3 . PLAN APPROVAL NUMBER
•
4 . MODEL OR COMPONENT DESIGNATION
5 . MANUFACTURER ' S SERIAL NUMBER . (0 U1/CJ
6 . DATE OF MANUFACTURE - 72,3 1g
•
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.
i * _ * * * , , * * * * * , , * * * * ; * * * * 'I * * ' * * * '* * *
•
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 -LONING 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 � 0-- - -
Owner, owner'.s agent,arcnitect, ontractor
•
* * * * * * •* * * * * * * * * * * * * * * * -* * * * * *. * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE` PERMIT: • •
•
•
•
• By •
`Down (I Quen1ury APPLICATION FOR SEPTIC DISPOSAL PERMIT
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801 DATE /
LOCATION OF PROPERTY FOR INSTALLATION .77-2 �/)2 ) ez, ,, qY1
OWNER'' S NAME tAa.....tia
ADDRESS a,� c'2 2,..,..,,TEL 792-6 3 q 3
INSTALLER' S NAME �.. �S f P1 LL.4 O�L/J TEL �07- 7a �7
a ,
Number of bedrooms (residential only)
Total daily flow(compute @. 150 gal per bedroom) :SO()
Topography: yjmaI - Rolling - Steep slope - (circle one) % of slope
Soil nature: S= - Loam —Clay - Other Depth ft.
Ground water -At what depth? / 4/ ft.
Bed-rock or impervious material - At what depth? . . )/T ft.
Percolation test - Not required - Required - -Rate min-inch.
•
Domestic water supply - •- Well - Other
Separation - Watersupply(if"well) from Septic absorption ft.' ,I
Proposed System: Septic tank / QO gal. ( Minimun size, 1000 gal. )
Tile Field - Each trench. ft. Total system legnth ft.
Seepage pit(s) Number of / . Size each /[) ft X 2 ft
Size of stone to be used #. 3 Depth or thickness j' ft.
IMPORTANT ! ! -
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 -lines 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 arid agree
to abide by these and all requirements of The Town of Queensbury
Sanitary Sewage Disposal Ordinance.
Signature of responsible person /_i/Y2
9fa-e )
Date
05/86 and/vl
Section II Septic System Inspections:
• A. All applications for septid system installation,
alteration or repair, as reauir..ed 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 locationAf 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 ofup 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..
awn o/ Queenitury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION it./-1/4yei,...CAN-e—
DATE rp76 / Q{cC( PERMIf NO. U - 5
SOIL TYPE • Loam - Clay -
Percolation • -st Required? YES gig
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS4Number of) C
Size— (c ft. X q ft.
Gravel s ze
PIPING: Size Type
Bldg. to tank V" 10
Tank to dist. box _
Dist. box to field/►• 1
Openings sealed? NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption _ ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYST )ID OPERTY(circle one)
Front - Rear - Leif t side Right side -
CCMMENTS:
\\)\
SYSTEM USE APPROVED41,1"
NO
CA/711/41)Zt -
Building Inspector
01/86 and vl
c.etitel
cc9 l 0t GD I ' 3 : `o
awn oI Queenatury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME Kecr i c IIsPrir� cf
LOCATION 1 ' siC.hilow( 4U •
DATE lid.,q / V. PERMIT NO. IL- 3-/96"
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS-fNumber of)
Size- ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box _
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits ft.
ON OF SYSTEM ON PROPERTY(circle one)
ront - Rear - Left side - Right side -
ENTS:
(341)(
SYSTEM USE APPROVED Y S NO
Buil ing Ins ctor
01/86 and vl
_locun o� Queen ur/
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME kG.r/ S f/ h�'
LOCATION p/> i (//.i 1' 14v
DATE I J(y / ff6 PERMIT NO. 86 -
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required?. YES - NO
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 ft.
Gravel size
PIPING: \Size Type
c.
Bldg. to tank
Tank to dist. box
Dist. box to field/pit , '
Openings sealed? YEV\NO Partial
LOCATION/SEPARATITS:
Foundation to tauk ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS:
ke"0/
Ar/yea
SYSTEM USE APPROVED YES NO
4/11 /1Z::57-
Bui�c&`ing Inspector
01/86 and vl
Jown o f Queeni1ar,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
•
NAME
LOCATION 01‘;der
DATE 1602Z/ igg PERMIT NO. � `fb
SOIL TYPE - and Loam - Clay -
Percolation 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 _ ft.
Gravel size
PIPING: Size e
Bldg. to tank
Tank to dist. box _
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption _ ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYS OPERTY(circle one)
Front - Rear eft side Right side -
COMMENTS:
(94( %-f-c-et
,G�
C c�
ce7
SYSTEM USE APPROVED YES (57
Ct fit'
Building Inspector
01/86 and vl
brtoW 3—y
_Down of Queeni1urcy
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
1\
LOCATION i/J/�,Cjfi`.Q r�I e„co,o-Jd
Date_ / �� Permit No. ('( Li 5—
* * * *. * * * * * * * * * * * * * * *
✓ APPROVED - YESJ�/ NO
noting/Pier Forms ,� OcG.
Foundation
Waterproofing
Backfill .
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
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- -
60/16/uittO
Building Inspector
6/86 and-vl
FREE ESTIMATES SNOWPLOWING
DAN SAVILLE JOB ESTIMATE
General Contractor
P.O.Box 824
Glens Falls,N.Y. 12801 Phone:792-0875 PHONE DATE
JOB NAME/LOCATION
TO Kati P R71ringPr
24 Jerome St
Glens Falls New York
JOB DESCRIPTION:
This is a estimate pour a concrete slab Rxhh with a monolith hasp.
Footing and 4" cPn=Pro
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LoAl MpI/Dc,r F o07-40cG^
ESTIMATED
JOB COST
THIS ESTIMATE SHEET BECOMES A CONTRACT UPON
APPROVAL BY SIGNATURE
ESTIMATED
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