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2011-422 01111K TOWN OFQ UEENSBURY 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201 ��� Q rY, .o. Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20110422 Date Issued: Monday, September 26, 2011 This is to certify that work requested to be done as shown by Permit Number P20110422 has been completed. Location: 44 PINELLO Rd Tax Map Number: 523400-308-019-0001-054-000-0000 Owner: CHARLES VROOMAN III Applicant: CHARLES VROOMAN III This structure may be occupied as a: Mobile Home Out of Park By Order of Town Board TOWN OF QUEENSBURY p Issuance of this Certificate of Occupancy DOES NOT relieve the 7-P, avP �,/ property owner of the responsibility for compliance with Site Plan, xtf. Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement Planning Board or Zoning Board of Appeals. } TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20110422 Application Number: A20110422 Tax Map No: 523400-308-019-0001-054-000-0000 Permission is hereby granted to: CHARLES VROOMAN III For property located at: 44 PINELLO Rd in the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: CHARLES VROOMAN III 44 PINELLO Rd Mobile Home Out of Park $54,000.00 QUEENSBURY,NY 12804 Total Value $54,000.00 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2011-422 1456 sq ft mobile home $174.72 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 24,2012 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the To ff ueensbucy; Nyedn>Resday,August 24,2011 SIGNED BY r :g for the Town of Queensbury. Director of Building&Code forcement R ' .3 D� ^ i _ s---</' OFFICE USE ONLY sF I er TAX MAP NO. PERMIT NO. )1-14?-7---DATE ISSUED: PERMIT FEE )74 APPROVALS: ZONING TOWN CLERK i ' 111"` • TOWN OF Qs�LEN.3.ij' SUILOTNG& CODES MOBILE HOME -APPLICATION FOR PERMIT: A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a valid building permit has been issued. Applicant Information Property Owner Information Name: 0,4/lei tQ 1 /n4P, VT Name: Address: 4/i/ R�')C I/o R'N Address: eQcis 3 ' XIV /dray Phone No. /5151 1 790?'8:533 Phone No. Parcel Information �/ J Proposed Date of Placement: Property Location: f77 Pie&l0 Rb Road,Street,Avenue Name of Mobile Home Park: (if applicable) Tax Map Number: Jl/ f. 17- 1-51-1 Mobile Home Information = Zoning Information Approximate Value of Home:$ 51.4ouo Zoning Classification: New Home:jRfres 0 No Size of Property: dcb ft.prby acc)ft. Replacement Home: N'es El No Existing buildings: 30x a1 t ccvy_ 1,.3 � Size of Mobile Home: ft. by ,,� a ft. Setbacks: front yard �� . A. rear yard I[ ft. side yards il'T1. ft.and 9 ft. Singlewide: Doublewide: r^ Number of Rooms:(exclytle baths) J Accessory Building(s): Number of Bedrooms: jj Number of Bathrooms: a Detached garage:❑1-car '2-car ❑ car El Gas Fireplace 0 Woodstove 0 Wood Fireplace Attached garage: ❑1-car 0 2-car ❑ car Foundation Support: Storage building: El Yes CI No Type Size & Depth Other: Piers Runners Water Supply: ❑Well rigmunicipal Slab $ ( $a !o" Is Septic Permit Required? ❑Yes ❑No Continued on page 2 ` � -Town of Queensbury• Community Development Office • 742 Bay Road, Queensvury, LV r 1Lou Name of Installer or Mobile Home Dealer: Address: Phone: rCq Complete information below found on a"Plate"or"Sticker"which is affixed to the mobile home: 1 I y� ✓ Insignia serial number: ✓ Name of manufacturer: ✓ Plan Approval Number: I Model or Component Designation: (New home only) I Date of Manufacture: _^.fL•i!1ii^..-i!i .S:^.!-^..i_:_^.fiK^.l:y^ AFFIDAVIT iy M V z Town of Queensbury State of New York County of Warren r J � V L swear that to the best of my knowledge and belief the statements contained in this application, together with the plans 53 and specifications submitted, are a true and complete statement of all proposed work to be done on the described premises and 5 that all provisions of the BUILDING CODE, the ZONING s 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 owne Signatu Owner,Owner's Agent,Architect,Contractor ✓..�.�.i✓u✓.�:�:1-- __ -:�.�.�:i.-i.r..i.r:�.r.-�.+.r.+:i✓.s✓:s✓w�.r.s:�.r✓.r.a.'u✓.�.:s:i:�:wi.+.�:r:�.r:�:wr..r:�.+� SPECIAL CONDITIONS OF PERMIT Jj fjJf/ � By: Code Enforcement Officer '' Town of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804 I I, 41 ZZ._ . Revised-41.141211111,„ OFFICE USE ONLY ILIA t Vignii TAX MAP NO. PERMIT NO. PERMIT FEE AUG 2 2 2011 Lo APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: TOWN OF QUEENSBURy A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUB 'U''!alzil '4,,,41 ISSUANCE F_A VALID PERMIT. ]�" OWNER: /IHi ��S t4 V roorn4'!7 0 INSTALLER: ADDRESS: ' / � ►'1e//6 ' V ADDRESS: rig PHONE NOS. b)- g53 3 PHONE NOS. LOCATION OF INSTALLATION: RESIDENCE INFORMATION: NO.OF COMPUTATION TOTAL DAILY FLOW • YEAR BUILT BEDROOMS X (Gallons per bedroom) ' GARBAGE GRINDER 1980 or older X 150 = INSTALLED? 1981-1991 X 130 = SPA OR HOT TUB 1992-present 3 X 110 = 334D INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING )61STEEP SLOPE ' %SLOPE I SOIL NATURE: SAND )0LO CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? H I BEDROCK/IMPERVIOUS MATERIAL AT WHAT DEPTH? Iv/� ✓ DOMESTIC WATER SUPLY: MUNICIPAL r WELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS /"S PER MIINUTE PER INCH(mpi) (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). TANK SIZE: APO kL301NLIIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,spa or whirlpool tub. SYSTEM TYPE: ,-. r 0 ABSORPTION FIELD(WITH NO.2 STONE) Total length /J 0 ft. Each trench Z x SU o SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? 0 ALTERNATIVE SYSTEM Bed or other type? 0 HOLDING TANK SYSTEM Total required capacity? Ta siz ` Number of tanks? NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. For your protection,please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or circumstance known by or on behalf of an applicant,shall be void. I have read the regulations with respect to this application and agree to abide by the - d all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanitary S. •--1..' D , 'isposal Ordi ance. codesaqueensburv.net / /f,,,M .-. $iaIy VISIT OUR WEBSITE FOR MORE INFORMATION Ignature of Person Responsible Date www•queensburv•net Town of Queensbury*Community Development Office*742 Bay Road, Queensbury NY 12804 1 rrVO ) 7 , i. -- Q bury Building & Code Enforcement— Manufactured / M• •,!i -r Final Inspection i7t, a • ju 9 'AO a pm Office No.(518)761-8256 Arrive: 2.=. �- Date Inspection requ_ received: Inspector's Initials: -- NAME: NAME: L" DATE:�� !1{� PERMIT it /� /1- g2.2._ `/ LOCATION: I C� 7 23 �// Manufactured Home +I (../^ Modular Home 7 y c-L Lk--2,7 Footings_ Foundation_ Backfill_ Framing Comments: Yes WA Foundation support,pier spacing, Per manufacturer Anchoring per manufacturer 2'from ends i Water line shut off /7/ Sewer line support©4 feet Heating Crossover[doublewide}off grd. Vj Dryer vented outside ,fi Skirting ventilated 1 sa.ft.ner 1.500 sa.ft. ://i Hot water relief valve piping outside Deck,porches,steps,railing Furnace/hot water operating Garage Fire proofing J Fire Door/Door closers \i/./ J Plumbing Fixture/3"Vent through roof[Modular] Foundation insulation fif applicable] Smoke/Carbon Monoxide Detectors/Interconnected t6 5 Final Electrical Variance required Data Plate okay E-__ C____C,\ Manufactured HUD seal okay Warranty Seal after January 1,2006 I ii 1'/ / \ L.1 1\-\ L`&_ Installers Warranty Seal i , �� 18"x 24"access or 22'x30'attic access apor retarder under home 6 mil poly or other i9 t t' t 11 Street number I Okay to issue CIC or CIO[temp./Perm.] ,\/7 . t U F f. E 17 LA) model# v`T2.,- C'�' I MSerial# 3'14 v\12 c7.-c2,- Manufacturer �u° ��i �% Date of Manufacturer q SL' L:1Pam Whiting\20101Building Codes Forms\Manufactured Modular Final inspection 03 04 10.doc OGt./.6J.6V11 VJ.JJ rL`L rL/.L .L 'tLV`7rVA1 J.I.000G JJ .? ;.7.1-000.C.;...1-LL"., .C-4-1 . . 1 INSTALL NO. 15 871 STATE OF NEW YORK DEPARTMENT OF STATE ONE COMMERCE PLAZA P d 99 WASHINGTON AVENUE ALBANY,NY 12231 INSTALLER'S WARRANTY SEAL THIS SEA I.REMAINS THE PROPERTY(:)1'THE DEPARTMENT OF STATE NEW MANUFACTURED(HUD CODE) 0 RELOCATED MANUFACTURED(HUD CODE.) A. Manufacturer's name: .S K7114 B. HtJT)label number: PFs log,.._q/3 F' )u q -17 Serial number: 32/01 Z. C. Retailer's name: Serer1 i ty lip tkj tf — -- I). Retailer's address: 2 I3$ �v�hl.- IJ hi( &ls.h>7 % J9 - 4W-26' 1, Retailer's certification if: l'clephone#: Rig—._ 1�J8(,,, --)Y__.� 0 I F. Installer's name: . ./2;44.51ePetit ZIG Ci. Installer's address: /6\ 11-h AS RD e.l•.'f e-GCod C, 0 H. Installer',certification#•,1---1-1A-.... -_C C�L .-....�—LL/z Telephone it: �1/�.= .5123-----. • 1. Date installed:—., 9—/L7./-8 __. Municipality issuing building permit: C.�!.c•K4'��4y �✓ ` — J. Customer name and physical ddress (91 1)where home is installed: (City,1bwn. Vi1Iap.L ) owl, Vrod tq�__ 1- I ✓ n el lQ ._...-.. I`Q SJ' V..- . /1,4.. . ,New York. By attaching this SLAT.to this manufactured home,the undersigned Installer ofthis manufactured ltonmc warrants as follows: I. That the installation of this manufactured home meets the standards of the New York Stale Unilirnn Dire Prevention and Building Code. 2. That the Installer is certified as an installer by the New York State Department of State. The foregoing warranties are in addition to and not in derogation ofall other rights and privileges which the consumer may have under any other law or instrument.The I rcgning warn ' ies are in addition and no •n limitation of or substitution lug,any and all other warran- tics,express or implied,given r • e y .• e staller, ' intra; a 'y or by operation of law. Printed Nae of Person Signg Seal: G; ' 1�% Name — _ Signature of Installer or Limited Installer: •• -. If you have a problem with your home,you should first contact your installer or retailer.Tithe problem is not resolved by the Installer or Retailer you can euntact the Department of State at(518)474-4073. uou.16 c(Rev.(1:3/09) Yellow Copy •Ocpariment of State White Copy—R Iain for Your Records Goldenrod Copy—Perndtting Agency Seat -Affix to Home (3 ..0t-_-)) 0 — 9 7/t, Or.77x->to- ,,, Queensbury Building & Code Enforcement— Manufactured / Modular Finsir Inspection Office No.(518)761-8256 Arrive: am/• De•ark 312(am/pm Date Inspection request ived: Inspector's Initials: , IS NAME: t41-C47)it PERMIT#: l-- �- LOCATION: 1/4/ 1 /11x'.-/E1f:kijDATE: Cie-7 7/ Manufactured Home Modular Home Footings_ Foundation— Backfill_ Framing_ Comments: Yes • No WA Foundation support,pier spacing, / j���rf-j e Per manufacturer v d Anchoring per manufacturer 2'from ends , / c-,- -utz-- A- -41S Water line shut off • Sewer line support @ 4 feet Heating Crossover[doublewide}off grd. // Dryer vented outside V Skirting ventila • 1 .ft. • . 1 1 I --• :. of water relief valve • •• •- porches,steps,railing - /./....)Th Fumace/hot water operating Garage Fire proofing '‘°V Fire Door I Door losers / Plumbing Fixture/3°Vent through roof[Modular] `// Foundation insulation[if applicable] vv, / Smoke/Carbon Monoxide Detectors/Interconnected•01 a- , vval Electricaliredata Plate okay ... anufactured HUD seal okay arranty Seal after January 1,2006 stallers Warranty Seal 8"x 24"access or 22"x 30'attic access Vapor retarder under home 6 mil poly or other 911 Street number Okay to issue C/C or CIO[Temp./Perm.] _ l.,014%/1A- VIOLL�/ Model# Serial# `� l Manufacturer Date of Manufacturer L:1Pam Whiting%20101Building Codes FonnslManufacturedModular Final Inspection 03 04 10.doc / /A bir-SiCr‘W, Foundation Inspection Repo Office No.(518)761-8256 Date Inspectionjequ r- ' Queensbury Building&Code Enforcement Arrive: i b : I.,pDepart: 742 Bay Rd.,Queensbury,NY 12804 Inspector's Ini ,. / am' NAME: f ((�� - -�- 'ti' ' I T#: / 4'Z2 LOCATION: 4 t. � , PC/ INSPECT ON: TYPE OF STRUCTURE: ,(+4I, LE„ ytrA , Comment' y N Footin Piers Monolithic Slab \91\ Reinforcement in Place The contractor is responsible for providing protection from freezing for 48 hours following the placement of the concrete. Materials for this purpose on site. Foundation/Wailpour Reinforcement in Place Fooling Dowels or Keyway in place Foundation Dampproofing Foundation Waterproofing Footing Drain Daylight or Sump Footing Drain Stone: 12 inch width 6 inches above footing 6 mil poly for wet areas under slab Backfill Approval Plumbing Under Slab PVC/Cast/Copper Foundation Insulation Interior/Exterior R- Rough Grade 6 inch drop within 10 ft. L:\Building&Codes Forms\Building&Codes\Inspecbion Forms\Foundatlon Inspection Report.doc Last printed 12/20/2005 9:24:00 AM Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Amlre:. •- > :am/pm Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: { I NAME: a. A PERMIT NO.: LOCATION: -ft (--,, INSPECT ON: 000- RECHECK: I f Comments and/or diagram Soil Type: t;j' Loam/Clay Type of Water: 1ci.• ./Well Water Waterline separation distance ft• ,. cit:.2,,C>i ` �'' Well separation distance ft. Other wells: ft. 1"` , ..i , t.c*-3 Well Casing Length 50' +/- Y N N/A [150'to well required if NO] fll t ,, ' -- \; i- — Absorption Field: Total length ft. Length of each trench ft. Depth of trenches i_`-" ft. Size of Stone ..644 Seepage Pits: Number Size: Al i Stone Size: _ Piping Sze Type Building to tank 3 ..., Tank to Distribution Box `" 5 i" >� 4 . / - -- Distribution -- Distribution Box to Field/ Pit Lk ` ,-;-- Opening Sealed: Y N End Cap _KY....�.N „ \ '„° °r Inlet/Outlet Pipes&Baffles Y N -2„, ic,r-- . Manholes Manholes 12"or less below grade N;A [provide extension collar if Yes] Y P N/A- Location /At ocation/Separations � ` �- -- Foundation to tank -------�ft. Foundation to absorption ft. -----"_ Oh iiki P -r Separation of Pits ft. ,a- Conforms as per Plot Plan Y_,,_X_ __. _. .... -._._- __ —_—___________. .___._ 4_.-------- , Engineer Report and As-Built Y Liv„,_ i " a c I , -.- . - -tet. „.„,,,---"--- ETU , -"-- . ETU Maintenance Contract Y-,L. provided Location of System T.roperty: Front �Rear,,,) Left Side Right Side Middle Front Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspection Fomes\Septic Inspection Report_03 29 10.doc RESOLUTION AUTHORIZING REVOCABLE PERMIT TO LOCATE A MOBILE HOME OUTSIDE OF MOBILE HOME COURT FOR CHARLIE VRO OMAN RESOLUTION NO.: 255,2011 INTRODUCED BY: Mr.Ronald Montesi WHO MOVED ITS ADOPTION F l i CY1Py SECONDED BY: Mr.John Strough WHEREAS, in accordance with Queensbury Town Code §113-12, the Queensbury Town Board is authorized to issue permits for mobile homes to be located outside of mobile home courts under certain circumstances,and WHEREAS, Charlie Vrooman filed an"Application for Placing a Mobile Home Outside of a Mobile Home Court" to seek Town Board approval to replace his mobile home with a new, 2012 mobile home on his property located at 44 Pinello Road in the Town of Queensbury,and WHEREAS, the Town Board duly held a public hearing concerning this application on Monday,August 22m,2011 and heard all interested persons, NOW,THEREFORE,BE IT RESOLVED, that the Queensbury Town Board hereby authorizes the issuance of a Revocable Permit to Charlie Vrooman in accordance with the terms and provisions of Queensbury Town Code§113-12,and BE IT FURTHER, RESOLVED, that the Town Board further authorizes and directs the Community Development Department and/or Town Clerk to take any and all actions necessary to effectuate the issuance of such Permit and the terms of this Resolution. Duly adopted this 22"d day of August,2011,by the following vote: AYES: Mr. Metivier,Mr. Montesi,Mr. Strough,Mr. Stec NOES: None ABSENT: Mr. Brewer