1987-005 BUILDING PERMIT
TOWN OF QUEENSBURY No. 87-05
5( FA4ci WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to John P . Telisky
Michigan ave . o
OWNER of property located at Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Mobile Home Flo
at the above location in accordance to application together with plot plans and other information hereto filed and y
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1 . OWNER'S Address is 33 Orville St . -c
Glens falls , New York
2. CONTRACTOR or BUILDERS Name
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3. CONTRACTOR or BUI LDE WS Address pp'
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4. ARCHITECT'S Name
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6. ARCHITECT'S Address
6. TYPE of Construction — (Please indicate by X)
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{ Wood Frame ( ) Masonry I ) Steel ( 1 Cr
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7. PLANS and Specifications
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No_ 1986 Skyline Mobile Home - Model 5188 Hampshire - Serial No . 0612-W PW
Using existing septic system .
8. Proposed Use
Mobile Home Dwelling
$ 25 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES August 1 19 87
(if a lorger 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
--13th Day of January 119 87
SIGNED BY / i �- - for the Town of Queensbury
BuiidIng and Zoning Inspector
TCI BE C :-. .rLET9D BY PLL+C . DV11T .
Application No.
owns Os�eens�srre� Permit Issued ] {�
BUILDING and ZONING DEPARTMENT Permit Expires i'1_ �O"V ��
Say- anti HaviFand Road, R.D. I Box 98 zoning Designation Fi
Clueensbury, NOW York1 12801 Variance No . ' `y + >l !
_ _ ! Site Plan Review No *
APPLICATION FOR Approved s ,,�AI �1 l9 " � �- J
MOBILE NAME 5 �
131411516
BUILDING AND ZONING PERMIT _�• ? • .
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 slaecificatic3ns submitted, and such
special conditions as may be indicated on the Peewit .
The owner of this property is : ::Lc) f ' r .. rS 44;;:7-y
P . O. Address � *J (!) a Vj% I y
e S ! L ,e s i
Property Location : k 0 �'c.� , ,g AJ A v & Tax Map No . lz7 :3 13
street dumber or building lot number -
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION OF 'WORK. AS REGARDS 13011,I)ING CODES IS :
Name P . O. Address
'P+�1 . No .
Nacre of installer 16 r A .per s! Address �j o � � (� {� L e , + r � l� C Tel . ��¢� `/ C!� Z�
Name of plumber 0%j 7GC__ . Address Tel .
Name of masonil Address _ Tel
MOBILE HOME INFORMATION : * ZONING INF-ClF'vATION :
New Home placement ' A PLOT PLAN Musam DLL PREPARED AND suamiTTED ,
drawn► reasonably to scale and attached hereto ,
�+
Replacing existing Home showing clearly and aistinctly all buildings ,
Size of new Home ft X ft whether existing or pruposed and indicate all
Single wide / set`back dimensions from property lines . Give
g �/ Double wide * street and number or lot number and indicate
No . of roams excluding loaths ] * whether interior or corner lot . Show location
} * Of Water supply and location and configuration
No * of bedrooms cX' * of septic disposal are.. .
Noe of bathrooms ] T_ COMPLETE INFORMATION lu'.QUIRED BELOW .
Fireplace? Wood stove? /"t �' " Size of property ft X /Gp f Pf t'
Foundation style and size : * Existing building ( s ) :-Jize ft x ft .
Piers No . of Size- ft x ft. -
'� Existing building ( :s ) Use
r^ N V� Depth below grade f t.
* Proposed building , EJi ; tance froLm property line
POWDATION = 'Footing size�- ` S • Front yard ft Rear yard ft
Wall material. �.�,eK�e * Side yards-ate ..� c�ft and ft
wall thickness." Height ft . * If on corner , serback from side street tt
Total depth below grade ft .
" OCCUPANcY INFORMATION
PRSNyArRY BUILDING -
Grade to Home floor level�,�y ft . LZR family dw4 t 1 i rt
y 9
Two family dwell ink;
Proposed date of placement -/ ,+ * Multiple dwelling / Number of units
Aprox . value- of Home $ c2 �gza Permanent occ ul,.rncy
Transient occuparicy
Water supply - Well Municipal. * Business
Industrial.
Septic Permit required?_ axe -S jiAll'.
* If addition, what will use lx ?
FURTHER INFORMATION REQUESTED * ACCESSORY BUILDING-
ON THE REVERSE SIDE OF THIS SHEET , * Detached gar- 4rcle/raiYw car/ two car/ car
Attached garage/rare Car/ two car/ car
* Private. Storaqe 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
le INSIGNIA SERIAL NUMBER
2 . NAME OF MANUFACTURER
3 . PLAN APPROVAL NUMBER -
4 . MODEL OR COMPONENT DESIGNATION
5 . MANUFACTURER ' S SERIAL NUMBER _-
�S . DATE OF MANUFACTURE
AZ Z the above information is to be found on a p Zu t. rj o2 sticker which
should be affixed to the MobiZe Home . Complete above with tYatxt infox7ncation.
Town of Queensbury __. ......._- -
County of Warren A F F I D A Y I 1 STATE OF NEW YORK
I swear that to the best of my knowledge and be 1 i- e f 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 t1le desc- ribed Premises and that all
provisions of the BUILDING COPE , THE ZONING ORDINANCE , and all other ,laws pertaining to
the proposed work shall be complied with, whether specifa. eci or nc>c , and that such work is
authorized by the owner .
owlAirr Signature ------ __--- - - - ------ ---�-;-�����--
owner ' s aas�e r, t: , arcn �ect , contractor
it w : * +r • * * ,r + * r * * * � sr se !t * ► t fr * * # * tlr � � � * x * , * � * * * ,► s * * at tk
SPECIAL CONDITIONS OF THE PERMIT :
..
1
V41MM 0*rn of
APPLICATION FOR SL 771C IDISPOSAL PERMIT
DATE
LOCATION OF PROPERTY FOR INSTALLATION ,L! ct�� to F1 J �jf"1 '
Owner's Name* �^� t? �,�} +�-y" �� � is 5 Teleph[�ne: / �' 3f
Address: Is: ' .. f �t t� .t} -J fyVC0 -e e 5
Installer`s Name: �/ �,"�//�,! /r Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one Fla Rolling Steep Slope % of slope
Soil Nature: circle one: Sand oam Clay Other J Depth: feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: depth? _ f,[ r feet
Percolation test: circle one: not required required / rate min. inch.
Domestic water supply: circle one: Municipal ell Other
IF domestic water supply is a Well: �__--
Separation: Watersupply from Septic absorption i feet
PROPOSED SYSTEM : Septic Tank . gal. (minimum size: 1 ,000 gal.)
TILE FIELD : Each Trench feet / Total system length feet
SEEPAGE PlT(5) : Number of / Size each feet by feet
Size of stone to be used # / Depth or Thickness _ feet
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALI.EI?
(over)
Section II Septic System Inspections:
A. All applications for septic system installation, alteration or repair, as
required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted to the Building 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.
I have read the regulations above and agree to abide by these and ail requirements
of the Town of Queensbury Sanitary Sewage Disposal Chxiinance..
Signature of responsible person: �
Date:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY A GOOD. PLACE TO LIVE
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Qu p,, n yb "ry
BUILDING and ZomING DEPARTMENT
Bay and Haailand F;oad, R D• 1 Box 98
QUeensbury. New York 12801
SUI I.DING INSPECTOR ' S REPORT
NAME �T 6 ~
LOCATION { c
� ] permit NOv -- *
* * * * * * * * * fee APPROVED - 'Y L3t7
y4Faoting/Pier Forms
Foundation
waterProofing
Backf i ll
Framing
Roofing
siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext , Porches
Finished Floors ;
Interior Trim
Stairs & Railings_�__.�- --�
Cellar Chain Tile
Concrete g]oors�
Plbg - gix.tures
Gar . Fireproofing
poor Closers
Smoke Detectors
1
Chimney
-INSULATICAI * {
Foundation
Floors
walls
Ceiling
FINAL ELECTRICAL INS ECIIC)N
I)RIVEWAY ApPROV Survey
Final Building
t scheduled insP
action (call when ready
Nex
Remar'ks-
Building IT"speCt`� r
�/86 and-vl
YORKARD OF
BUILDING DEPT. COPYHIS OB rAPPLICATION.WITH FORM
BUt 46-ELa NEW DIFNa DEFT WHE REQU1REpIRE �NDERWRITER3,
TEMP i DATE t
COUNTY / 7 �'+ •� '"r
. p� POLE NO.
STREET AN6 NO. OR �-,: Iq
ROAD AND POLE NO. 4D 23 ! . ] LOY f i
BETWIFIE WHAT 7YfO T tiJ il TION BLOCK
CROSS $T REETS IS L.n_.� ` (,. :.,.1 r.1 ;1 : 'I` —
PREMI ATED7 -r BUILDING j ,�11'�y�? /�/ -
OCCUPANT'S �� �,., F per, L . {` 3 .I[ �' `i ♦ DOl`UPA�+FM.W//' !� -+� "� f
NAME �J pp yr- /1 L.. J { LJ{; TE L. # �] „1 S�/ f
OWNERS NAME -,Y.- '`�,F. �. v /L f r I r-•' /
AND ADDRESS -? .,y t
SUIn" 111INIII
PPLIED t 1 _ FROM TriE1R DEFECTS E
gY WORK NEW ADDITIONAL ❑ REMOVED
BUILDING OLD IS
IS NEWT
«, LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLEDOFFICE USE
No. of Fixtbrea 6 MOTORS HEATERS - BRANCH CIRCUITS ONLY
NUMBER OF OUTLETS Lamp RaceptneWs _
LOCI
H.P. Watts Na. 'e'GW j' INSPECTIONha than Switch Pendant N0. Typs Each No. Each
Callingyra" Reeep'MI
Out-
aide
amb-
been
Boer
mart
let FI.
Zed FR.
3rd FL
DO NOT USE THIS SPACE,
REMARKS: LIST OTHER ELECTRICAL DEVICES HOT SET FORTH ABQVE:.
i ant to be irupaetad hux if at time Of inspection there I, JoUn i edd itianal equipment not above fisted,
This aPPlicatiOn is intended to Covm t the above-1 istod �i0 to caner the MCWnional Muipn+em. at provided by the APPI icant.
you are authorized tO make the inspectionTOTAL
ELECTRIC SIGN WATTS
SIZE OF FEEDERS LAMPS
MAINS EXPOSED GAS TUBE SIGN VA
CHARACTER CONCEALED TRANSFORMERS OF 1CAPACITYI
OF WORK iµUMBERI
WORK TO BE COMPLETED SIZE OF SIGN
STARTED UNDERGROUNO MAKER
SERVICE OVERHEAD pF SIGN
ENTERS
IL I a OLD
INSPECTION REQUESTED NEW
ON OR AS NEAR AS } f S^ J ,y•
POSSIB Lf r
VOID DELAY RY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES APPLICATI N /J
MUST BE FILLED IN OR APPLICAYI ON MAY BE RETURNED. ` ■ SIGNATURE f
PRINT NAM.'ErA,� r-�DR ` r !i �y a �L, , �ifi f T ( OF
NAME OF — } �`') 4C tir � _'•] �j � � ' `�( �,.!
APPLICANT_ {� I f, LTELEPHONE
STREET ADDRESS ZIP L LICENSE NO.
y r• + ; . �7 WHEN APPLICABLE
(" r3 f CODE
T OFFICE (` UILDING
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(aEv. easy A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE B
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