1987-323 1w
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+CERTIFI+CA T OCCUPAN Y
TOWN OF QUEENSSURY
WARREN COIUNTY, NEW YO►RK
July 27 , 19 87
Date
8i—:323
This is to certify that work requested to be done as shown by Permit No.
a has been completed.
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This structure may be occupied as a i xob I l e Rome dwelling
l Locarion Howard 5 t
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Gary Fisher
Owner
By Order Town Sward
TOWN OF QUEENSBURY
/ Building & Zoning InSPOCtor
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v BUILDING PERMIT
TOWN OF +QUEENSBURY No. 87-323
WARREN COUINTY, NEW YORK
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PERMISSION is hereby granted to Gary R . Fisher
OWNER of property located at 'Howard St . Street, Road or Ave. ,
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in the Town of Queensbury, To Construct or place a Mobile Home Dwelling
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at the above location in accordance to application together with plot plans and other information hereto filed and K
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1 . OWNERSAddressis 127 4th St , Ext .
Glens Falls , New York. 12$01
2. CONTRACTOR or BUILDER 'S Name
Kenneth Fisher
3_ CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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En
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5. ARCHITECTS Address
B. TYPE of Construction — (Please indicate by XI
( I Wood Frame { ) Masonry { ) Steel { ?
7_ PLANS and Specifications
12 ' x6O ' per plot plan , specifications and application including
No. sewage system - 1975 Mark IV Mobile Home — Serial No . 7014-74
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8. Proposed Use
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Mobile Home Dwelling IS
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$5 . 00 C/o
$ 25 ' OO 'PERMIT FEE PAIL? - THIS PERMIT EXPIRES !, J;anitary ] {� —
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of C{ueensbufy before the expiration date.l
Dated at the Town of Queensbury this 4t h Day of June 1987
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
Tt) BE COMPI,UTLD 1AY Is1.1_Cr . DEPT , U L� T
Application No .
Jate�n r� ISP� ►i tC►ftrt� Permit Issued 1 JUN 2 WI
BUILDING and ZONING DEPARTMENT permit Expires 19
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation BUl1..DIN 8C CODE DEP"T,
Queensbury, New York 12801 variance No. P G E, +S j/,-10
C3 / -- a;,a;, J" Site Plan Review No .
CA� PPL. I CATION FOR Approved by :
MOBILE HOME �
FU I LD I NG 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 specifications submitted , and such
special conditions as may be indicated on the Permit .
The owner of this property is :
P. O. Address Z� ? c/ r rr ,sa` 4-x r- � A4 '/_ /' Z 'Pe�y / Tel .
Property Location : 7- t0 <'" rTax Map No, l� �' /
Street i .umber or building lot numtaer
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS %
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Name P . O. Address Tel . No .
lAtfis
Name of Installer 7.: brays e2AD OCRn! Address itr90 ws rz ' Tel . 7 3 2
Name of plumber. .1 •" ey, Address ,/22 der.,r c G cr e- . Tel . "7 9^ Z 2� 0 A n
Name of mason ��. �_,xcc�.r Address 2 v �*.co ror gE:�c r �! Tel . 9 :?, _ r. cc+
MOBILE HOME INFORMATION : * ZONING INFORMATION :
New Home Placement A PLOT PLAN MUST BE PREPARED AND SUBMITTED ,
- " drawn reasonably to scale and ,attached hereto .
Replacing existing Home showing clearly and dIaZArsctly all buildings .
Size of new Home ft X I is ft w whether existing or proposed and indicate all
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 )
of water supply and location and configuration
No . of bedrooms_ " of septic disposal area .
No * of bathrooms / ,. COMPLETE INFORMATION REQUIRED BELOW .
Fireplace? k. Wood stove? " Size a £ property S d 7�+ 0 w ' f t X .rS a f t .
Existing building ( s ) Size + s� ,ft X ft .
Foundation style and size :
Piers- No . of-.� Size-fi t x ft . * Extsting building ( s ) Use ZeL Pp :,,: .:7
Depth below grade_� ft . * s
Proposed building , distance from property line.
FOUNDATION - Footing size . 4wvW X
„ Front yard 3*� ft Rear yard f a ft
Wall material * Side 'yards Aw ot Ft and ,t v'
ft
Wall thickness Height ft . * If on corner , setback from side street ft
Total depth below grade ft . * OCCUPANCY INFORMATION
* PRIMARY BUILDING -
Grade to Home flour level r'7 ft - One family dwelling
Two family dwelling
Proposed date of placement y./ Lr /-e-2 . Multiple dwelling / Number of units
* Permanent occupancy
Aprox . value. of Home $ 4 r' �' Transient occupancy
Water supply - Well Municipals * Business
Industrial
Septic Permit required?_ Orther
* If addition , what will use be:' Jh ,car-
FURTHER INFORMATION REQUESTED + ACCESSORY BUILDING-
ON THE REVERSE SIDE OF THIS SHEET . * Detached garage/one car/ two carj car
Attached garage/one car/ two car/ car
* _Private storage building
other
*
Form MT1P 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
la INSIGNIA SERIAL NUMBER
2 . NAME OF MANUFACTURER
3 , FLAN APPROVAL NUMBER
4 . MODEL OR COMPONENT DESIGNATION AX K Jam' a= Z9 tom$
5 . MANUFACTURER ' S SERIAL NUMBER rI � "
6 . DATE OF MANUFACTURE
All the above inf6rmation is to be found on a plate or sticker which
s )tau Zd be aff i.xed to the Mob i 2e Home . Complete above with that information.
Town of f Warren �y F F I D A +V I �' STATE OF NEW YORK
County of Warren r1 1 1J 1
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 -.z ... ...
+Owner , owner ' s agent , ra •`cnirect , Contractor
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SPECIAL CONDITIONS OF THE 'PERMIT :
APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE ,ate,/ f / d*
LOCATION OF PROPERTY FOR. INSTALLATION � � , �._�/A�P, % j Ott
Owner's Name: .
Telephone: / � .7rCt7e'iCJ
Address: ��.� �Jsi!
Installer's Name: n , Telephone: Z
Number of bedrooms (residential only) _ AM _
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: Flat Rolling Steep Slope °r of slope _
Soil Nature: circle one: !and Loam Clay* Other, / Depth: feet
Ground 'Water: At what depth? -/V7% eV E06 feet
Bedrock or Impervious Material:w At what depth? feet
Percolation test: circle one: not required required J rate min. inch.
Domestic water supply: circle one: qAMRicipaj Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank ,f tp V, gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of dtJ Size each �7 . t feet by JrX feet
Size of stone to be used # _= / Depth or Thickness /#2 o-o` feet
I M P O R T A N T
_..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, the 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 $250.00.
Co An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
I have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: _ •'y' s �- ' .___ T'
Date: 9/ eo ,� ++
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792--5832
SE -rTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD- PLACE TO LIVE
,,, �ueenSbur+e�
flower EPARTMEt1T
BUILDING and ZO"%NG D � BOX 9$
gay and HavNand Road. R-C?.
QueensburY. New York 12801
BUILDING
INSPECTOR ' S REPORT
NAME L III •�
LOCATION 6 d T
tee ` / '�__ permit iao .
* * o
* rl
* * * * * * * * • APPROVE - YES
Footing/Fier Forte
Foundation
Waterproof ing
Backf ill
Framing
Roof ing
Siding
Masonry Vene
Rough plumbi.n
Relief Valves
Ext . Porches
Finished Floors
interior Trim`
stairs & gailirti�3s
r Drain Tile r
Cella concrete Floors
Plbg . Flyture s
Gar . Fireproof in
,,or Closers
Smoke Detectors
chimney
IN SULA'�IO1`1
Foundation
Floors
Walls
Ceiling ICAL I135P'ECTIOt3���-
FIi3AL ELEC
17R1V WAY A RpV A
Final
Building Survey�� -��
eetlon (calf when ready) ,
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scheduled iTts'p
ein k`0
Remarks �p `'�� ��•
auiiding inspector
6/a6 and-vl
J � gown Of 'bCueenjbury
..�" Sl}ILOING and ZONING OFPARTMENT
Bay and Havifand Road. R.D . A Box 98
Oueensbury. New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME_
LC)CAT ION
� ] PEWIT
DATE
nd Loam - clay
SOIL TYPE - Required? YES
Percolatio Min/
Percolation rate
Inch
TYPE of SYSTEM total length
Absorption fie ,
Length of each trend►
Depth of trenches��--�-- - _
Size of gravel r of )
SEEPAG PITS-(Numb
size- ft ' X
Gravel size Size Type
PIPING =
slag . to tank
'Tank. to disc , boas
Dist* box to field/pit
No Partial
openings sealed?
LOCAT ION/SEFA'RAT I ON S : �,�ry f t.
Foundation to tank r i • £t.
Foundation to absorption
ft :
Absorption to lot line ft,
Separation o£ pits TY (circle one)
YSTEM de
C713 PROPER
1,r,7CATIC9t1 _ Right side
Front - ea . Left si
COMM,EN
SYsTE24 13SE APPEtOVFD
NO
Building Inspector
01186 and vl
THE NEW 'YORK. BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
41 STATE STREET, ALBANY. NEW YORK 12207 s
S eCeluber 28 , 1967 Application: No. on file 01469t4 /87
Dote �
THIS CERTIFIES THAT the + aeatiora number in the promises of 3e
ortiy the electr" ,sya,ipment as described belo+e and in[r.s.o'+ c '++ by roans maned an she afaoae ayipL _
a
Gary R. Fldher , rioward Street , W o Glens Falls * New York
Section 124 BLoek 1 Lvt $
in the following Location; ❑ Basement 0 1st FL. ❑ 2" FL, Ou t s i d es �
as examined on 7 / 1 / 67 and found to be in compliance with the requirements of this Board*
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Ci IN
FXrEES RI►1r
COOKG COCKS OVENS DISH WASHERS EXHAUST FA
NXTURE GENS
EPTACLES SWITCktFLUORESCENTpt§�tNT FLUORESCENT v aMT- K,K. W. Amt. K. W. AMT. K.W. AMT. K. w, MIT.
OUTLETS
UM -r HEATERS MULTI-OUTLET DYMMERS
DRYERS FURNACE MOTORS FUTURE APPUAHM F111MRS SPECIAL RRC'FT TLME CLOCKS ROLL SYSTEMS AMT. WATTr
AMT. K. w. pL M. P. OAS
H. F. AMT, t+a. A. W. G. AMT. AMP. AMT. AMPS. TRAMS. AMT. M. P. Mp, OF FEET
S E Y I C E
SERVICE DISCONNECT �of W. o, wa. or w uEc A.w. a. ►ao. op NEU R^LS os i�imeAt
AA{T. AMP. TY►E EOWP. X 7w 1 .r 3w 9 / 3w S JI 4W Nd. ��FEY 1� b OP CC- CONb. OF FNfECa
i 22 i 4
1 10(] Cb i x
OTHER APPARATUS.
.��r�� LY7►'y R
K.ennetkz D . Fir�her � � r
4th Street Ext !Ji 6RANCH MANAGER
Glens Falls , New York 12Y01
Per
must not be altered in ony monnerT return to the office of the Board if incorrect. Inspectors may be identified byhei their C
This certcertificateredentials.
ED IN ANY MANNER.COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTER -
town of
Queen314Ary
BU .[)
IL[)tNG and Z4f[fhlG R , 1 N4 X 9
r f B Quee sbury. New 'ti'ork�128�j8
I SPECTOR ' S REPORT
BUILDI
NAME ,�. ,/
LOCATION d C
/7 Permit 130 . %_, r1,�-
Date
APPROVED - 'YES NO
k
oting�Pier Farms
undation
Waterproofing
Back-fill
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
Flours
Wails
Ce i 1 i ng
FINAL ELECTRICAL INSPECTION
�---�
DRI VFWAY APPROVAL Survey
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Final Building
Next scheduler3 insp
action (call when ready)
Building Inspector
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