1987-194 CNER.TI11+CATE OF OCCUPANCY
TOWN OF QUEENSSURY
WARREN COUNTY, NEW Y+ORK
cp�o�)
Date_ August 2:3 19 '
' } �C4 � .� 87- 194
This is to certify that work requested to be done as shown by Pee MM+�►itt N� o.
has been completed.. ojk ��7b %*
Mobile Home 33we1.1ing
This structure may be occupied
as
Location ' i s enhawer S t .
"tG
L7ona E Gale
Ownerliiiiiiiiiiiiiiiiiiiiilli
AS 1 v\ 'T 1 MIS By Order Town Hoard
AS YER I.ISPE IONS
T(7Whi OF QUEE1.7S8URY
ON
(A" '
'+ r
Suildin h ,,ing inspector
BUILDING PERMIT
TOWN OF QUEENSBURY No. 87_194
WARREN COUNTY, NEW YORK
t=1
PERMISSION is hereby granted to Donald E . Gale w
OWNER of property located at Eisenhower St . Street, Road or Ave. rn
in the Town of Queensbury, To Construct or place a Mobile Home Dwelling['
In
at the above location in accordance to application together with ,plot plans and other information hereto filed and m
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1 . OWNE WSJ Address is P . 0 . Box 6
Gansevoort , NY 12831
2. CONTRACTOR or BUI LDE R'S Name same
r�1
r•
m
3_ CONTRACTOR or BUILDER'S Address co
O
i4
r-i
4_ ARCHITECT'S Name cn
rt
6. ARCHITECT'S Address
a
B_ TYPE of Construction — ;Please indicate 6y X1 �
r
; ) Wood Frame { ) Masonry ; 1 Steel ; I
m
0
7. PLANS and Specifications M
1986 Redman Mobile Home Model 6683 V
No, Serial No . 16270 — including sewage system
S. Proposed Use
Mobile Home Dwelling vc
$5 . ao CIO
$ 25 - 00 PERMIT FEE PAID — THIS PERMIT EXPIRES November 1 79 87
(if a longer period is required an application for an extension must he made to the Building and Zoning inspector of the
town of Queensbury before the expiration date_)
Dated at the Town of Queensbury this 23r-�d,� -Day of _ April i9 87
SIGNED BY //'/ for the Town of Queensbury
Building and Zoning inspector C20
// TO 13E COMPLETED BY 1ILDG . DEUT .
uw+ra o SrPB1i36tll t� Application No . QtJF11- t i?Y
Permit Issued
BUILDING and ZONING DEPARTMENT Permit E.x fires lq 15
Bay and Haviland Road, A,D, 1 Sox 98 Zoning Designation
Dueensbury, Now York 12801 variance Ua . La
I- Do
Site Plavivu7tew No . AtJH " 1987
AP P I 1 ^ T r h•' R Agprov B'.JIL."oNG 8c CODE DEPT.
KIIEw
PU I LD I NG AND ZONING PERMIT
A PERMIT MUST BE OBTAINED AFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING .
The undersigned hereby applies for a Huilding 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 .
The sowner rof-this�property TIs : � 121n,-�, � � � _ +
Q1 [ �:
P . o. Address r. e - ! c st l Gs 1 . ' lG � aY. Tel . .? 9G--' C= _ r a
Property Location : r C . '} , 4a g ram^ Q6L� V. r' � . QE.'een,j Gorr y Tax Map No ./.z'z'f f /`L'�. •f'
Street s:umber or building lot number
TILE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS :
Name Y. O. Address Tel . No .
Name of Installer Address �� "SLt�' oa Tel .
Name of plumber 7'At." jA, ? cij fcv_j2� Addrous _ Tel . S <-7
Name of mason Address Tel .
MOBILE HOME INFORMATION : * ZONING INFORMATION :
New Home Placement yr le �y
A PLCYr PLAN MUST bV0 PREPARED AND SUBMITTED ,
T drawn reasonably to scale and attached hereto ,
Replacing existing Home * showing clearly and distinctly all buildings ,
Size of new Home. �`ft X��q ft whether exist in"I ur proposed and indicate all
set-back dimensiUns from property lines . Give
Single wide Double wide * street and. riumbt7r .} r lot. number and indicate
* whether interior r>r corner lot . Show locatior"
No , of rooms (excluding ba tits )
of water supply ur,cY location and configuration
No . of bedrooms '" of septic dispo -.u1 area .
*
No . of bathrooms * COMPLETE INFORMA t'10N REQUIRED BELOW .
Fireplace?.ELL - Wood stove? A.; C " size of prop,erLy .____ 311 - � ft x 20-.0 ft .
Foundation style and size : Existing kauilciiny ( s ] size ft X ft .
Piers- No . of Size-�ft x ft . " Existing buildlny ( :I; ) U:;e
*
Depth below grade
Proposud building , disLance from property lime
FOUNDATION - Footing size "" X "
,. Front yard q .3 f ft Rear yard 4 . /r Pt
Wall material * Side yards ,a O ft. and f t
Wall thickness." Height ft , +► If on corner , ser.F).xck frr-rn side street tt
Total depth below grade ft . * OCCUPANCY INFORMATION
Grade to Home floor level ft . * PRIMARY BUILDING -
* It * x * * * * * * * tr "t ,t * * It * * One family .awe 1 1 i rig
* Two family dwr- 1 1 icty
Proposed date of placement / / * 14ultiple dwc: lliiiy / Number of units
Agrox . Value of Home $ ;2 C' [ � � * Permanent aCL-u} IuriCy
* Transient oct:: uio�xrnc-y
Water supply - well Municipal „ fiusin+ess
» It3dustrr ia �
Septic Permit required? V40� * Other
* If addition , what will use b.4:'
FURTHER INFORMATION REQUESTED
* ACCESSORY BUII.UTrIG-
ON THE REVERSE SIDE OF THIS SHEET . * Detaa-hed gar. <>.3€:�'olak: car/ two car/ cur
" Attached r'a a c g F /urge car/ two Car/ car
Private story:"Fe building
* other
i
Form MHP 5 / 86 and - vl
APPLICATION FOR MOBILE HOME PERMIT , C CONT I NUE D)
State of New York Division of Housing and Community Renewal
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
1 . INSIGNIA SERIAL NUMBER V F S 11fi,' O
2 . NAME OF MANUFACTURER + e wyy } V%.:
3 . FLAN APPROVAL NUMBER
4 . MODEL OR COMPONENT DESIGNATION , 3
4
5 . MANUFACTURER ' S SERIAL NUMBER .+l+� 2 1 a
6 . DATE OF MANUFACTURE
All the above information is to be found on a 7 :.r. G or sticker which
uhould L (:� aJ'fixed to the Mobile Horne . Complete abovr:> % th that infonmation .
Town of A F F I D A V I T STATE OF NEW YORK
eensbury
Warren County off Warren
I swear that to the best of my knowledge and belief the statements contained
in this application , together with the plans and specifications ciulimittedo are a true and
complete statement of all proposed work to be done on th.� descrlbesd premises and that all
provisions of the BUILDING CODE , THE ZONING ORDINANCE , and s11 other laws pertaining to
the proposed work shall be complied with, whether specifit2d or xioL . and that such work is
authorized by the owner .
a J
Signature _s. s ,,,� --� --- ---- -- --__
OW r , aw�fier ' s at)ent , arcnttett , contractor
at # Mr * * * * Yr 7t +P s Mr * • * k i * !� !r tY * !r * # tr ak of � tF rF i+e � w 1• +t * +� � * to iF yr x rt at
SPECIAL CONDITIONS OF THE PERMIT :
`y--------------------_,____ ...........
s
tayowm af
APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE LTAr^r d2 2
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: U iC ��tc^ Telephone: `„ ' C Cam '
Address: Ir G" '/• c� f z r'! av `C," �c3��r-
Installer's Name: y GG ' f fc + Telephone:
Number of bedrooms (residential only) _ ' _
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: Flat Rolling Steep Slope 9'0 of slope
Soil Nature: circle one: and Loam Clay Other / Depth: _ feet
Ground Water: At what depth?
Bedrock. or Impervious Material: At what depth? �� feet
Percolation test: circle one: of re equired / rate min, inch.
Domestic water supply: circle one: Munici a ell Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM : Septic Tank _ �4� gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench fc+ ��.
SEEPAGE PIT(S) : Number of / Size each 4%jr feet by 14910� feet
Size of stone to be used # _ _ / Depth or Thickness ya , feet
IMPORTANT
...Please...LIST NEW EQUWMENT TO BE INSTALLED
gob NOW40W "SA spin As fcww�
+.L _ ` SFr ,yt '� O r IS" PA C* %VerS
(over)
Section Il 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 dryweils
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 agme to abide by these and all requirements
of the Town of Queensbury Sanitary 'Sewage Disposal {(.Ordinance.
Signature of responsible persono.ok 1)le 4
I4 Date: tf2 � q
"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
Q +' awn a/ 'Queensbury
BUILDING and ZONING DEPARTMENT
Bay and Hawiland Road, R.D_ 1 Box 98
Queensb►ury, New York 12801
�r
BUILDING INSPECTOR ' S REPORT
NAMEj `7 /
LOCATION 1
Date- ���= '� - Permit No . �1 �
tt * * * * * * * * ✓* APPROVE * 4*YES* NO
Footing/Pier Forms
Foundation
Waterproof ' nc�
Backfill
Framing
LjWaf ing
---+ iding ,
Masonry Ven r
Rough Plumbi
4-1�1 .ef valves
f . Porches
t, r'3-n ished Floors
t�fnterior Trim
g-tai.rs & Railing
Cellar Drain Til
concrete Floors
LPTbg . Fixtures
Gar . Fireproo ng
Door Closers
L.Stuolce Detect rs
Chimney
INSULATION :
Foundation
Floors
walls
Ceiling
�NAL ELE TRICAL INSPECTION .
DRIVEWAY ROVAL
Final But ding Survey
Next scheduled inspect/ion (call when ready
Remarks- /90-Z+'"L�
66
Building Inspector
6/86 and-vl
_/overt o� �ueen3bure�
BUILDING and ZONING DEPARTMENT
Say and Hlaviland Road, R.D. 1 Box 98
Queensbury, New York 12601
BUILDING INSPECTOR ' S REPORT
NAMELOCATION
Date—! / Permit No . �s
✓ = APPROVED - E NO
Footing/Pier Forms
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
DRIVEWAY APPROVAL
Final Building Survey
Next sclieduled inspection (call when ready)
Remarks-
Build nng Inspector
6/86 and-vl
c�
Q So
vc cii