1987-254 - T
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MIN
PPPP
CERTIFICATE OF OCCUPANCY"
TOWN OF +QUEENSBURY
WARREN COUNTY, NEW YORK
Date October 6 , 1987 19 87
This is to certify that work requested to be done as shown by Permit No. 8Z-254 '
has been completed.
This structure may be occupied as a One-Family Modular Tswe113n
Location Richardson Street
Owner Francis Girouzs
By Order Town Board
I
IrOVdrN OF QUEENSSURY
I
Bui1dsna & Zoning Inspector
I
f
BUILDING PERMIT -
TOWN OF QUEENSBURY No, 87-254
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Francis Giroux
n
ri
OWNER of property located at Richardson Street Street, Road or Ave.
N-
in the Town of Queensbury, To Construct or place a One—Family Modular Dwelling
m
at the above location in accordance to application together with plot plans and other information hereto filed and n
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
>C
1 . OWNE WS Address is 13 Dixon Court
Glens Falls , New York
2. CONTRACTOR or BUI LDER'S Name
n
same ar
w
rt
a
m
0
3. CONTRACTOR or BUILDERS Address
m
same rt
n
ro
ro
rt
4_ ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction — (Please indicate by X) (D
�+7
( 311 VVoad Frame I ) Masonry ( ? Steel ( 1
N•
r-�
7. PLANS and Specifications
No. 24 ' x48 ' per plot plan , specifications and application including
sewage system and two-car garage (under) r
r•
S. Proposed Use Oq
One-Family Modular Dwelling THE ATTACHMENT OF THE TWO PARTS
Poloron Homes of Pa , Inc . MUST BE APPROVED BY A LICENSED
PROFESSIONAL ENGINEER .
$5 . 00 CIO -
$ 94 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES Dece . 1 1987
(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 14th Day of May 19 87
SIGNED BY "d£, a.. eQA=4� for the Town of Queensbury
Building and Zoning Inspector CzAry
TO BE COMPLETED BY BLDG . DEPT . T'0WN OF QUE0046M
Jvwn O/ Quedmigur Application No. 10
Permit Issued 19
B lun�5
UILDING and ZONING DEPARTMENT
Permit Expires 19 r
Bay and Haviland Road, R. O. i Box 98 Zoning Designation (gyp- / Gr
Queensbury, New York 12801 variance No . I BUILDING $ CODE DEAT.
13 /� / f Site Plan Review No .
4 I Approved ]� : W lie +ter- 4
APPLICATION FOR (f -Oje /4 J �
BUILDING AND ZONING PERMIT
A ds': r/d7;0eL./ 6', -C r' Q : lotA PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION , ANSWER ALL OF THE F0LLOW-N& - e w,
The undersigned hereby applies for a Building Permit to do the following work which willr" /
be done in accordance with the description , plans and specifications submitted , and such
special conditions as may be indicated on the Permit .
..........
The owner of this property is : F"'n! [.I S Crw 1 lep UX __________________________________
P . O. Address t3 D + Kenn Caur'r r^1e &% S /W7+ Tel .
Property Location . Ri 4/%Axv eA Sa v% Sr r e G"f Tax Map No , / f
Street number or building lot number
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING.ocODES IS :
GL. e�A15 5 - 9 3-r.13 68'
Name F . O . Address Tel . No .
Name of builder _Address Tel .
Name of plumber Address Tel .
Name of mason Address Tel .
NATURE OF PROPOSED WURK : ZONING INFORMATION :
+!Construction of a new building A PLOT PLAN MUST BE PREPARED AND SUBMITTED ,
Addition to a building drawn reasonably to scale and attached hereto ,
Alteration to a building showing clearly and distinctly all buildings ,
(no change to exterior dimensions ) whet_her existing or proposed and indicate all
Other work (describe) set-back tons from property lines . Give
street and number or lot number and indicate
FOR DEMOLITION PERMIT . STATE SIZE AND * whether interior or corner lot . Show location
LOCATION OF STRUCTURES AFFECTED_ of water supply and location and configuration
* of septic disposal area .
COMPLETE INFORMATION REQUIRED BELOW .
* Size of property 410WX ala. X rC0 ft X AFQ fto
* Existing building ( s ) Size ft X ft .
PROPOSED BUILDING AND USE : �
eI Existing building ( s ) use
Site of new structure r I ft x 07y,Of
a
Foundation-pier/slab/crawl/partial fu3 '" Proposed building , distance from property line
(circle one )
No . of stories (habitable space ) Front yard ft Rear yard ft
Height ( grade to ridge ) a ft . Side yards �,p ft and rla �( ft
If residential. , no . of families If on corner , setback from side street ft
No . of rooms ( excluding baths ) _ OCCUPANCY INFORMATION
No . of bedrooms
No . of bathrooms PRIMARY BUILDING -
Primary heating system * Ae'�One family dwelling
W 44.e /I. Two family dwelling
Type of fuel Multi le dwelling
No . of fireplaces to be installed Na +VG p 43 / Number of units
Will a wood stove be installed?mod - Permanent occupancy
Central Air conditioning? N d Transient occupancy
* _Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
Ranch Contemporary Log cabin * Other
Raised ranch Mansion Duplex * If addition , what will use bet
Split level Old style Bungalow
Cape Cod Cottage Other ACCESSORY BUILDING-
Colonial Row Town House Detached garage/one car/ two car/ car
{ CIRCLE ONE PLEASE ) * Attached garage/one car/ two car/_� cax M �ty.�
* * * * * * * * * * * * * * * * * Private storage building 11111
ESTIMATED MARKET VALUE OF Other
CONSTRUCTION
$ ? � oaa
INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEETr TO BE COMPLETED !
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction ,(:wood frame fire safe , etc .
Will any second-hand or ungraded lumber be used? I £ so , for what ? 0
Foundation wall materi.al_" �d Thickness
Depth of foundation below grade ( to bottom of footing ) CYII .
Will there be a cellar? Aft) Heated or unheated? Floor sq. footage sq ft
Will there be a basement? YeS Will any portion be used as living space? -�'v'�` �► +G
( If so , what portion? sq . ft . - - Type of use?
Type of roof - sloped/flat/shed/other 'TZI X Material of roof az A*. I
Size , wood studs „x� _ •" spacing 6 J"o . c . length 7 �6 � ft . 47 C an AVj;f%4)r' wiwoLs
Joists ( floor beams ) lst . floor ' •'x spacing f "o . c . span
Joists ( floor beams) 2nd . floor " X "' spacing "o . c . span ft *
overlays ( ceiling beams ) "x spacing ""o . c . span ft .
Hoof rafters "" x It
spacing o . c . span ft .
Roof trusses (pre-engineered) spacing_Y"o . c . span I4A ft .
Exterior wall finish Vdr v1o%y _�_ 3�� d�rs�N Of what material ? V . y
Interior wall finish _ pwewl �d keCtY'oC-ok
If a garage is to be attached , describe materials to be used for FIRE SEPARATION :
6 " • brr- /ass r, sdfa"iq J 51P& ' -MC SAems-' rw.A On edi Lhn I'0 ` %VAS" � 5#T A+ ovo� it1
Is there to be an opening between garage and dwelling? ./ CS if so will a Fire-rated
door , enclosure , and self-closing device be provided? ��re S
Will a flue-lined chimney be installed? *V 0 Height above roof ft .
Depth of chimney foundation below grade ft .
Depth of fireplace hearth ft _ in .Water supply - Municipal or private well OV e n w
tAw,16vy "rnw, -f+"der
SEPTIC SYSTEM _✓ Distance from ANY private well ( includi.ng adjoining properties ft .
(A separate application is necessary for any repair or new installation of septic system)
C c Town of Queensbury A I T I D A V I T 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 submittedp 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 .
SWORN TO BEFORE e
ME THIS Signatur _.45"___ _ ___rr 1
__"_4'
_Owner , -owner s agent , arcnirect , contractor
day of 19
Notary Pub'1'ic , Warren County, N . Y .
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * tr
SPECIAL CONDITIONS OF THE PERMIT :
By_____ --
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work .
ANSWER ALL of the following : C
1 . Gross floor area �� `�' V
2 . Type of heat 60. &c0004, rA
3 . is the building mechanically cooled ? r% 0
4 , Percentage of area of windows and doors
A . Over 16 % Only
1 . - Uo value of gross area of walls , roof/ ceiling and floors
exposed to ambient conditions
2 . Floor over heated spaces YES NO
a , Are foundation walls insulated ? YES NO
1 . If YES , what is the R value ?
3 . Slab on grade YES NO
a . If YES , what is the R value of insulation around
perimeter of floor ?
4 . Is basement heated ? YES NO
a . R value of insulation
5 . Type of insulation
B . Under 16 % Only
1 . R value of roof and floors exposed to ambient conditions_
Roo, 3 t� cc: t r�, � ! 9 "fr too r,
2 , R value of exterior walls le 19
3 . R value of glazed area _ "rj%e "o%+ape�xt
4 . R value of doors
5 . R value of floors over unheated spaces'!
6 . R value of slab edge insulation - unheated slab
7 . R value of slab insulation - heated slab
8 , R value of heated basement/ cellar walls ( above grade )
9 . R value of heated basement/cellar walls ( below grade )
10 , Type of insulation d01*4T, 14&3 4f" efk!6. 11. `{roftW40.,
C . Controls
1 . Thermostat maximum heat setting
D . Duct Systems
1 . Is duct system installed in unheated spaces ? YES NO
a . If YES , R value of duct installation
b . R value of duct in other areas
E . Piping Insulation
1 . Size of hot water or cooling carrying agent pipe
2 , R value of pipe insulation
F . Service Water Heating f/
1 . Performance efficiency
2 . Temperature control setting maximum Lino
G . For Swimming Pool only
1v maximum heating /
Telephone No . �:' l3 056ir
( applicant ' s signature )
APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE ^!' / i5 fi
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: �G S C• l JC-D ?f Telephone* 2173 Q 3 6
Address: r .3 01 x0 N [ o u o.T (r/ C h g
Installer's Name: Telephone:
Number of bedrooms (residential only) 3
Total daily flow (compute @ 150 gal per bedroom) Ys5o
Topography: circle one:((Fl aV�`6olli Steep Slope % of slope
Soil Nature: circle one Sand Loam Clay Other / Depth* feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? feet
Percolation test: circle one: n t required required / rate /� min. inch.
Domestic water supply: circle o - Municipal Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank r04 U gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length ; 40 6 feet
SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used # +�2 / Depth or Thickness _��feet
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
(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 andd all requirements
of the Town of Queensbury Sanitary Selvage DispQoosal C W disance.
Signature of responsible person: F►" ^� "' � - '� �
Date:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792--583Z
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . A GOOD. PLACE TO LIVE
oj� Q"ee"t 4"ry
BUILDING and ZONING DEPARTMENT
Bay and Haviiand Road, R.D. 1 Box 98
Queensbury. New York 12801
BUILDING INSPECTOR ' S REPORT
NAME .
LOCATION
Date / Permit No :
APPROVED - YES NO
Footing/Pier Forma
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 . Fireproof' g
L.,aoor Closers .
Smoke Detecto
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROV►rt-
Final Building Survey
Next scheduled inspection (call when ready
Remarks-
Building Inspector
6/86 and-vl
� - 7 9r �
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R'0-
1 B x 98
Queensbury, New York 128 1
BUILDING INSPECTOR '' S� REPORT
NAME Cat' S C Yf C12-L/
LOCATION
Date 3� / _ Permit No .
✓ — APPROVED - 'YES N
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
fing
iding
Masonry Veneer
Rough Plumbing
LR2el ie f valves
fit . Porches
Lmf - lshed Floors
'interior Trimtlg a
tairs & Railings
Cellar Drain Tile
Vncrete Floors
g . Fixtures
iara Fireproofirt .t
�oor Closers
(y.uuake Detector
Chimney
INSL3LATION
Foundation
doors
Walls
Ceiling A
UPINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
(jt'Pnal Building Survey
Next scheduled inspection (call when -ready
Remarks- T) V ]
in.lc'
Building Inspector
6/86 md-vl
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
FA Y• 41 STATE STREET, ALBANY, NEW YORK 12207
Date October 302 1987 Application .Va. on fiiv 013027 /87 A 698810
THIS CERTIFIES THAT
weir the electrical equipment as described below and intro d"ca d by the applicasst named as* the above application number in the peemieem of
Francis Giroux , Richardson Street . Queensbury , New York
in thefoltaming location: ❑ easement ❑ lst Fi. ❑ 2nd FR. Outside Section 134eioll 6 Lot 11
mac examined on 8/3I87 and found to be in corraplionce with the requirements of this Board.
FIXTURE PTACLOS SWITCHES NXTURiES I RANGES ICOOKING DECKS I OVENS I DISH WASHERS EXHAUST FANS F
OUTLETS INCANOESCEM fUN3Mt5CtM AMT. K. W. AMT. K. W. MAT- K-W. AMT. K. W. AMT. H. F. }.
a-a
DRYERS FURNACE MOTORS FUTURE APFuANCE FEEDERS SFECIAL REC'FT TIME CLOCKS SELL UNIT HEATERS i�tt1LT1-OUTLiET DIMAMERS
AµT_ K, W. Ell N. P. GAS H, P. All Na. A. W. G. MAT. AJMP- AMT_ AMPS. TRANS. ArNT- M_ r. NO.
SYtiTEM3 AMr. WATTS
NO. OF FEET
SERVICE DISCONNECT NO. OP S E R V I C. E
AMT. AMP. T7rE EMI. UN I X 2W I X 3W 3 Ar 3W 3 J' AW No- *PER !'CONa. OF CC. COND. PlO. Or ml-LEG OF HI,r,G NO. OF MEUTRA.LS OF Muni
1 ZOO cb l 1 4/0 2/0
OTHER APPARATUS:
as
Jill
me
s
Francis Giroux � ,pn x
13 Dixon Ct . —L l BRANCH MANAGER
Glens Falls , New York 12801 �
r _
Per r
This ceRiftcate mist not be uttered in any manner; return to the office of the Board if incorrect.Jill Inspectors may be identified by their cradentiah.
COPY FOR 'BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
.� �r
_./own o
�+uQ�n .I �urt�r
BUILDING and ZONING DEPARTMENT
Bay and Haviiand Road, R. D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME �r
LOCATION
DATE � 2�� ' PERMIT CVO.
SCIL TYPE - Sand - Loam - Clay
Percolation Test Required? YES '- NO'
Percolation rate - Min/Inch
TYPE of SYSTEM;
Absorption field total length
Length of each t nch
Depth of trenches
Size of gravel
SEEPAG� m S4Nube f
Size- t. X t_
Gravel size
PIPING : size Tye `
Bldg . to tank '
Tank to dirt. box
Dist . box to field
Openings sealed? , YES I O p1axtia I. �
LOCATION/SEPARAT
Foundation to tank A ft.
Foundation to absorptiot.
Absorption to lot line �ft .
$e ion of pits ft.
ET OF SYSTEM oN PR PERTY (circle one )
n,t2Rear - Left side Right side:
i SYSTEM USE APPROV YE �NO,
Id I
Huildin nspector
\/86 and vl
.._. 9vn of "eensfiury
BUILDING and ZONING DEPARTMENT
Bay and Wavifand Road, R. D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ` S REPORT
NAME LOCATION
Date Permit No . Mc
✓ - APPROVED - YES NO ,
Footing/Pier Farms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext , Porches
Finished Floo3's
Interior Trim
Stairs & Railinc}s
Cellar brain Tile
Concrete Floors
Plbg . Fixtureg
Gar . Fireproofing
Door Closers
Smoke Detector's
Chimney
X INSULATION
Foundation
AAF
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVA
Final Building Survey
Next scheduled inspection (call when ready
Remarks-
Building Inspector
6/86 and-vl
-gown 0/ Queenji"r y
BUILDING and ZONING DEPARTMENT
Bay and Ha►+iland Road, R.D. 1 Box 98
Oueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME ,/
LOCATION � /'
Date�J/ Permit No . � - �
✓ = APPROVED YES NO
Fasting/Pier Forms
Foundation
Waterproofing
Backfill
)(F rami.ng
Roof ing
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 APPROV
Final Building Survey
Next scheduled inspection (call when ready
Rem ks-
3 ' hr
Building Inspector
6/86 and-vl
_Jotun o� �uQe,r-a! s �urc�
BUILDING, and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
L O C A T I O-/!N' 1 iC"f11dA4/- 5-i'?2 T
Date 40 '7 / _ Permit No . 82W —
✓ - APPROVED - YES NO
Footing/Pier Farms
iackfill
u.ndation
terproofing
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 scheduled inspection (call when ready
Remarks-
13uildi.ng Yrispector
6/86 and-vl
fI BUILDING and ZONING DEPARTMENT
f yip CR 1Bay and Haviland Road, R.D. i Box 98
Oueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME ( (J
LOCATION � . H 50 q
Date Permit Permit NO *
* * * * * * * * * * * * * * * * * * * & NO APPROVED -
mooting/pier Forms
Foundation
Waterproofing
gackfill
Framing
Roof ing
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
P1oprS
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY AP'PROVAI.__,
Final Building Survey
Next scheduled inspection {tali rahen r,(e'ady )
Remarks- h ,/L� 1't t4 [G ��L f DC47 lraclCt+�`(s
[..gc'rld - f o +.Jlf. C-0 O 'ti1&N
x ( u ro ,M(-5 4-
Pry
p AJ CG.,r,.rL�s
Building Inspector
6/86 and-vl
_ town oeseensbe�rr
BUILDING and ZoNING DEPARTMENT
G, ay and Havitand Road. R.D. 1 Sox 98
!' QUeensbury, Nev,' York 12801
13UI LDING INSPECTOR ' S REPORT
NAME
LOCATION
permil� Lao .
* APPROVED _ ygNO
otxngfpier Forms
Fo dation
Waterproofing
BackfIII
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
I N SU I.AT I ON :
Foundation
Floors
Walls
ceiling
FINAL ELECTRICAL INSPECTIO ��.. .�
DRIVEWAY APPROVAL Survey
Final Building —
.r Aol 6
p
ecti-on call
Next scheduled insRemarks 0& when ready
a%
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hiding4c:
and-vl
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FIR.£. Vr40£tyyyRI1EFtS-
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PPLICAT i
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REMARKS: L1ST '4� ELECT� the" is found
tNy but, it at tints o'I inapa�bV It" app"I- TOTAL
ant to adder iayal ogm:Pw'n• as Pw YywTTS
tQ .0 ew tlra at1��+Kt t trQpa lO C�'S� SIGN
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GEORGE *CUROSAKA JR.. P.E.
8611LOiNG SY5TEms CONSULTANT
pom5mr Box NO. 660
GLENS FALL'S, NEW YORK 12601
45101 792-152Z
13 ARBUTUS DRIVE
0UEENSBURY, N. Y. 12801
FHONC 4599 792 - 1522
BUILDIM INSPECTOR
Town of Queensbury re : Factory Manufactured Home
Town Hall installation certification.
Queensbury , New York 12601
Attention: Mack Dean
Dear sir !
This is to certify that I have observed and inspected the installation of a
"Factory Manufactured Home"' ; as defined by the New York State Uniform Fire
Prevention and Building Code , Chapter D - MANUFACTURED HOUSING , Article 2 -
FACTORY MANUFACTURED HOMES , as applicable to your local building regulations ;
there appeared to be no apparent structural damage to the units , due to or
attributable to the trap-sportation or loading/unloading of the units , hereirt-
after described as follows :
Date of Tnstallation:
'� ,i,G•,wrsS-j-.�.r,�C ,�I�•GtA�►i��`S"G•�le.� �T [..�'�"'�.'''' -�-.�-.7�.
Site Location,:
Community: Town of Queensbury
County : Warren
Manufacturer/Supplier : �,��„,,AW40• �`I�"lI� S of4O' 0%^'O�
Address :
Iris ignia Serial No .
Plan Approval No . ,�.,,r a a.s .S7-�
Manufacturer ! s Model/-Component No . :
Date of Manuf acture : COW
7
Installer/Supplier : �/"�i�IRR..JC,c. S C7/��-Ci 40#. 4
I have also examined the approved Plans & Specifications for the abovemerxtioned
"Factory Manufactured Home" t and to the best of my knowledge and belief , this
"Home" has been installed in accordance with these approved Plans & Specifications ,
and all other applicable laws cedes , ordinances standards &/Or regulations
� � NEB' /'}�if;�/,�' ,,"+i' Res tfull s mit ed�,
i 4 C's nuaaos .G +'
GEORGE KUROSAKA .TR m , P . E .
y = y
NXS PE Lic _ Na . 35869
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