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RC-000108-2016 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: RC-000 1 08-20 1 6 Date Issued: Friday, May 27, 2016 This is to certify that work requested to be done as shown by Permit Number RC-000108-2016 has been completed. Tax Map Number: 309.9-2-1 Location: 200 LUZERNE RD Owner: Homestead Village Applicant: Robert Lawrence This structure may be occupied as a: 980 s.f. Mobile Home 181 Adirondack Street By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, 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. 41FTOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building& Codes (518)761-8256 BUILDING PERMIT Permit Number: RC-000108-2016 Tax Map No: 309.9-2-1 Permission is hereby granted to: Homestead Village,Robert Lawrence For property located at: 200 LUZERNE 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 Tvae of Construction Owner Name: Homestead Village Mobile Home $40,000.00 Owner Address: 200 LUZERNE RD Total Value $40,000.00 Queensbury,NY 12804 Contractor or Builder's Name I Address Electrical Inspection Agency AGL Homes 4305 State Route 5 Caledonia,NY 14423 Plans&Specifications 980 s.f.Mobile Home 181 Adirondack Street 5117.60 PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,March 6,2017 (If a longer period is required,an application for an extension must be made to the code 1inlbvccment Officer of the Town of Queensbury before the expiration date.) Dated at the Town of eensb iday r 11,2016 SIGNED BY: for the Town ofQ �'ueensbu . Director of Building&Code Enforcement MOBILE HOME APPLICATION _office Use only Received DATE: �L J G Tax Map ID TAX MAP IDPermit No. ` Coo v U r Permit Fee 17+ CP PROPERTY LOCATION: /'? I NAME OF MOBILE HOME PARK: L PROPOSED DATE OF PLACEMENT: APPLICANT N of G �A ,-ptN ADDRESS ADDRESS 3 PHONE "' 1 PHONE !�— NAME OF INSTALLER OR MOBILE HOME DEALER a ADDRESS: 5 4, A) LIq-1, PHONE CONTACT PERSON FOR BUILDING&CODES COMPLIANCE [,7 PHDNE:l/ E ��` ! COMPLETE INFORMATION BELOW FOUND ON A"PLATE"OR"STICKER"WHICH IS AFFIXED TO THE MOBILE HOME Insignia serial number Name of Manufacturer Place Approval Number Madel or Component Designation (New home only) Date of Manufacture: MOBILE HOME INFORMATION ZONING INFORMATION Approximate Value of Home $ +/GC= Zoning New Home or Replacement I Size of property Size of Mobile Home ft.by ft. Existing buildings 1VOLVC Singlewide or Doublewide Accessory buildings !o/1 Number of rooms(exclude bath) Storage buildings Number at Bedrooms ] Detached Garage —1 2 `3 Number of Bathrooms Attached Garage —1 —2 `3 Gas Fireplace;Woodstove or Wood Fireplace Setbacks Front yard: Rear yard: x� ft. Side yard: /D {f, Foundation Support Size Depth Water Supply Well: Well: Piers ,Z� ,I !I Municipal: _ Runners Slab Septic Permit Required? Yes jy�-No 1 Town of Queensbury Building&Codes Mobile Home Application July 2014 Procedure for placing and occupying a mobile home or modular home: 1. Application is submitted and review: 2 copies of plot plan and layout must accompany application along with septic application (if needed)and fee. 2. Permit is issued—Permit card is placed on property 3. Footing forms are inspected before pouring concrete: Home is placed on foundation or piers 4. Arrange for electrical inspection—see"Certified Electrical form"on Town website 5. Septic Inspection, if needed 6. Final electrical Inspection 7. Stairs &.platform covering door width and door swing with handrails on both sides of platform and stairs are required for all exterior doors. 8. Final inspection by Building&Codes Department 9. All mobile/manufactured housing must be anchored to the ground upon which they are site per manufacturer requirements. 10. Installer Warranty seal must be provided at the time of Certificate of Occupancy 11. if anchoring is not possible due to weather conditions or any other item,.a Temporary Certificate of Occupancy Will be issued; Fee-$10; Deposit$100.00(refunded when all items are Ggmplete) DECLARATION: 1 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 ofthe Building Code,the Zoning Ordinance,and all other laws pertaining to the proposed work shall be completed with,whether specified or not,and that such work is authorized by the owner. Installer Warranty will be provided at time of Certificate of Occupancy. _ Date:Name: 1 6 Owne Agent, rtractor Signature: •✓ �'''~ Date: 3 Special Conditions of Permit: By: Code Enforcement Officer 2 Town of Queensbury Building&Codes Mobile Horne Application July 2014 INSTALL NQ. 2 362 4 STATE OF NEW YORK DEPARTMENT OF STATE ONE COMMERCE PLAZA I i 99 WASHINGTON AVENUE ALBANY,NY 12231 INSTALLERS WARRANTY SEAL THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE NEW MANUFACTURED(HUD CODE) ❑ RELOCATED MANUFACTURED(HUD CODE) A. Manufacturer's name: -- !�E l l F<! ' Serial number: - B. HUD label number: /--=_ S_ � � t1✓ C. Retailer's name: ' D. Retailer's address: E. Retailer's certification-#: _- I 2�% . -' ��` —Telephone F. Installer's name: CL Installer's address: e 1"` `f'` „ s"�'L- J.- !� ,7. -'L. ) ,,• . f s ' H. Installer's certification JTelephone#: � ,4 ~ I- 1. Date installed: r`L Municipality issuing building permit: (City,Town vllag J. Customer name and physical address (911)where home is installed: ' - ,r . ,z ,New York By attaching this SEAL to this manufactured home,the undersigned Installer of this manufactured home warrants as follows: 1. That the installation of this manufactured home meets the standards of the New York State Uniform Fire 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 of all other rights and privileges which the consumer may have under any other law or instrument.The foregoing warranties are in addition to,and not in limitation of or substitution for,any and all other warran- ties,express or implied,given or made by th -its 11 whether contractual) or by operation of law. Printed Name of Person Signing Seal - Signature of Installer or ��/ - r e j Limited installer: If you have a problem with your home,you should first contact your installer or retailer.If the problem is not resolved by the Installer or Retailer you can contact the Department of State at(5 18)474-4073. DOS-1580(Rev.03109) Yellow Copy—Departm ant of State White Copy—Retain for Your Records Goldenrod Copy—Permitting Agency Seal--Affix to Home Rdt PLO n &AiE .0 1 F SLE COPY �, TOWN OF qUE.NSBURY BUILDING DEPARTMENT Base on our limited exammatian,compliance with r comments shall Aot he construed as indic ng the pians and 3peafications are m �I full mphance with the,lBuilding Codes of NOTICE New rk State. R A HORING OF MOBILI HOME. 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