2012-237 wita. TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
Q ry,
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120237 Date Issued: Tuesday, September 10, 2013
This is to certify that work requested to be done as shown by Permit Number P20120237
has been completed.
Location: 200 LUZERNE Rd
Tax Map Number: 523400-309-009-0002-001-000-0000
Owner: HOMESTEAD VILLAGE L P
Applicant: HOMESTEAD VILLAGE L P
This structure may be occupied as a:
Mobile Home In Park By Order of Town Board
l TOWN OF QUEENSBURY
U.DkNA Ser,
i
Issuance of this Certificate of Occupancy DOES NOT relieve the property //
owner of the responsibility for compliance with Site Plan, Variance, or A- �✓��
other issues and conditions as a result of approvals by the Planning Board Director of Building& Code Enforcement
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
41, 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120237 Application Number: A20120237
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: HOMESTEAD VILLAGE L P
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. Type of Construction Value
Owner Address: HOMESTEAD VILLAGE L P Mobile Home In Park $50,000.00
4294 ROUTE 5 Total Value $50,000.00
CALEDONIA,NY 14423
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2012-237
New Mobile Home at 24 Windsong Dr.
$161.28 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,May 14, 2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town o ensbury• Mo u i .y�May 14,2012
SIGNED BY 4 41' for the Town of Queensbury.
Director of Building&Co.e Enfoo ement
• OFFICE USE ONLY , •
•
QQ qq •
P,4 �
TAX MAP N0 / �7-�'PERMIT NO. (oS—a DATE ISSUED: PT
PERMIT FEE 1 �/ ' /
(•�PPROVALS: ZONING TOWN CLERK ,• I
• ain ;
,
1 2012
1 TOi,VVN.O QLjcENSBURY
MOBILE HOME -APPLICATION FOR PERMIT: _BUILDING &CODES_____
A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a
valid building permit has been issued.
Applicant Information Property Owner Information
Name: / ie l/,%/e c . Name: ,4 /47/". ._5
Address: a JUzei?t_e_ Z./ Address: 4/-V5--- ,,,,/- c
fVoefe l ryi i .) /2. c/ C4hek,4/4 /t./. % /4,Z,3
1
Phone No.CS-*-S ) 303 - So!/ Phone No. C5 ) Z? -i/S
Parcel Information E. SP/
Proposed Date of Placement: S/ /2 Property Location: 07/7///J//e:Aer) t, ,
Road,Street,Avenue
Name of Mobile Home Park: li'rne5 !tilde (if applicable) Tax Map Number:
Mobile Home Information ` Zoning Information
-
Approximate Value of Home:$.50r(^400 Zoning Classification:
New Home: [Yes [I]No Size of Property: _511 ft. by ajOft.
Replacement Home: ❑Yes uffNo Existing buildings: AliD/Ve
Size of Mobile Home: as ft. by 44.57 ft. Setbacks: front yardO ft. rear yard/6:--ft.
side yards_ 4_ft.and /40 ft.
Singlewide: Doublewide:
Number of Rooms:(exclude baths) U Accessory Building(s):
Number of Bedrooms: i
Number of Bathrooms: Q Detached garage:❑1-car El 2-car n car
0 Gas Fireplace❑Woodstove 0 Wood Fireplace Attached garage: Ell-car ❑2-car n car
Foundation Support: Storage building: ❑Yes I- No
Type Size & Depth Other:
Piers pp y ❑ p
Water Supply: Well Munici al
Runners
Slab Is Septic Permit Required? ['Yes IRKo
Continued on page 2
Q, Town of Queensbury• Community Development Office ■ 742 Bay Road, Queensvury, iv r 1,6:5U*
05/07/2012 15: 41 5852266059 AGL SERVICE PAGE 02/02
Mat) 07 12 02:28p Homestead 5187922400 p• 2
J ,
•
Nave of Installer or Mobile Home Dealer_ )4
L r
Address: � %_ 4.0 1 Ar... � Rhone: ` 204 �/g) C)47 -37°.
1/.44b2r , /U' /c/c/t7
Complete li iftxiikition below found on a"Plato'oa"'Sticker'which is affixed to the mobile home:
Insignia serial number.
✓ Name of manufacturer. CN1 N- Ti? UFac-A-r�PG'r-27-14c. - C6 c7 ► th S
•
Plan Approval Number: _ //
✓ Modal ar Component Designation: s� ti c Z`S J�T 3 t4i5i/Z-
(New horneonly)
I Date of Manufacture: 5l o/ u7�Y/
-rerk3c 3-6
400 Play a'Pro' .AFFIDAVIT
uoT i4srlf c/ u+nT'L Town of Queensbury State of New York
! County of Warren
4Naat cr{tc *-1 � !/ �a�+ C E
beae gepTi4 '- I swear that to the best of my knowledge and belief the
7/ frvw -. cc statements contained in tlis 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 oruot,and that such
work is authorized by the owner.
Signature: Com, .CA�
.lwnet, s Agent, Contractor
a
S
SPECIAL CONDITIONS OF PERMIT:
13y:
Code Enforcement Officer
Tamm ofQsatensiiury• Community Dezdopmenf Office• 742 Bay RoadQueensbury,NY 12804
INSTALL NO. 19838 STATE OF NEW YORK
DEPARTMENT OF STATE
' 3 t.)
r ONE COMMERCE PLAZA (Uci
4 -11, 99 WASHINGTON AVENUE
ALBANY,NY 12231
INSTALLER'S WARRANTY SEAL
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE
El NEW MANUFACTURED(HUD CODE) 0 RELOCATED MANUFACTURED(HUD CODE)
A. Manufacturer's name: t« o i 1
B. HUD label number: NIA!"-166to7 NT f1 Serial number: Ltv%i110101yPCM 6
C. Retailer's name: 14 L t ,r r,
r f
D. Retailer's address: t i C& ts-4 , t. !�t \'o 1 i; ,1A� 1 NTLI _,
E. Retailer's certification#: riO,)5L I Telephone#: 5s5- �'C'f 77G�
F. Installer's name: 1-\C
G Installer's address: y �t, t- c; . l t s ,, ±
H. Installer's certification#: iC'C �I Li✓C� Telephone#: �, - C)2 )-7
L'
I. Date installed: c• ` ? ..' Municipality issuing building permit: L U c C t'•`)b-'Y
(City, own, 'liege)
J. Cust, ame and physical address (911)where o -' 'nstalled: 1"1a Y•! Q,i r C{ }-1„ « U,1\0
rj L i I n6Suvs (.lit ( )(: Cl)51^„ r,/ ,New York.
- i
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 the Installer,whether contractually or by operation of law.
•
Printed Name of Person Signing Seal:- --=- '.• " .
Signature of Installer or
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(518)474-4073.
DOS-1680(Rev.03/09)
Yellow Copy—Department of State White Copy—Retain for Your Records Goldenrod Copy—Permitting Agency Seal—Affix to Home
RX Date/Time 09/11/2013 10•:33 P.011
4d,%"1,4;JSeo, 11. 201310 40A,V.3,'sr,'Hoire unding findersv4i0. n' <v;%,:i '•:t••y.',..,,. Av No, 396 ,'• P, 11/18 '
A MIDDLE DEPARTMENT INSPECTION AGENCY, INC. c.,(-:$J
Yi
`) t that the electrical wiring to the electrical equipment listed below has been examined and is approved as -,5
N being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date
noted below and is issued subject to the following conditions. r,(a�
64 Owner: Homestead Village Date: 08/23/2013 3/) i' '
Occupant: Same Location:200 Luzerne Road Lot 24 1•J Ire So,C\ ict,
Queensbury, Warren Co. NY :.;;A
Occupancy.Single Family Dwg. ion,
k Applicant:
Robert Lawrence :,sr,; •:,
;rx„.' '�z. 'fray M�.
1,...',,.. 184 Adirondack Street 71..� • I, 1, yrs i.. GY�•�J Queensbury, NY 12804„f' .,4 t v , a:' .,„`. . '•' .., ''�`. ;, • Y t 4, ��
„ye
v off; • P. -';: ..r'' "•Q ,,'t1. K1. :' `
.
b
�/t Joseph A.Holme�5' >. F;,,ti:� ��' ,� 5
L
N . e%i 5'}`'�' ; a ratia':`'f•� ` �;ry A' z+.�•• .' rf` C•�
LO 3180 ' i E :. .z
J + F�,;;9M} 4'4104 4 s y 0
Equipment' °; h' �( � {('�� `` �., ,�, �1,:
51
4 } SD
10 4'.1
til .'
��?? 1 - 100 Amp Feeder To Hdme 4.
`,9 ..i $...j11.1...
,;i11.1;J+i,-.;, :,.:A.:., .,..:.'i,•._..... . ...-r.•'.” •K`�:�dj,"p”' +��' r” ��>' G'�
f. "'i'r, '.is. ._: f -1,`:.... .,y '4�' ty 1,a > y
.$ , N '!, �G .,. 5( erg}}
,C.v) ,.,f.. �'!•JQt•, Y[rahJ'�:>.:0}n1.X-A�fi.�'?. t. y. C�•>�
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lC 'r'•`•ci,'•;`w. =i�C.Lf:3%:Y. ,t7. �a F K VC,:
(C;Yj -Xj
($. This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void, This certlllcate applies only to the use,occupancy and .,,.
Ig above and the installation inspected as of the above noted dale based on a visual ownership as indicated herein. Upon a change In the use,occupancy or ownership er)
.7i inspection. No warranty is expressed or implied as to the mecnanical safety.eel• of the property indicated above,this certificate shall be immediately null and void. !').51
1
ss or the equipment for any.
at
ate shall In
e event
this
becomes
base
?��! be valid for a, clenCy or eperiod of one year 1mm the aboveuriotedrpose. This eats Should the electrical lecl�I thishce certificate Imay be revalidated ed upon rein apecUo upon Middlec,,. tne above„ '' ions, *��
t') system to which this certificate applies be altered in any way,Including but not limit• Inspection Agency,Inc. An application for inspection must be submitted to Middle ��r
?�7� ed to,the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc.to Initiate the Inspection and revalidation ,,;�?
�((.:•').'"\-.1E,•.
� any of the components installed as of the above noted dale,this certificate shell be process. A fee will be charged for this service. 54.
`.i,::n•• •-•::s.;>:yr�9%;'J;•:�••.vv7,'•:•..4. •..>in;.J:.�. i sy.� •i.•v,•••••Si 0•i�:47,5•�rr;�r+ •"� v "• \• v v v ,•:v, �.i t. M"�"t r����•�1�,
f4?••• •J4 ✓ ✓c i4`••• { ` .•`;‘• G•• •f•Jl.'�C s 1• C V, t'.' 54 rJr?.�rJ : 7..ri•::• i i:� Vi i.>.:J.J:
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r_-..�r.-_��`� ` �`..•';:✓ ✓ ✓i...7:tJJ��it';t3 ' e.:`a5 i> ;�'••S; .• ••ii;�iii�'�: L :e.;+.i�'r:%\.' i;•i:•�: r;'�;'l°:i:�•'^.i/••�'
�..�.� � ��% n• .'!v tis '�.� '�,� ''v'''.''�� . ✓.
0—• 0 ()1� 1t) -- ) 3 SEP 1 : 2013
Queensbury Building & Code Enforcement -- Manufactured / Modular Final Inspection
Office No. (518) 761-8256 Arrive: am/pm De art: 2 "/') am/pm
Date Inspection request received: Inspector's Initials: J�
NAME: fir +6)CC) PERMIT#: —cA-3
LOCATION: .-�x� ( L) D H DATE:
Manufactured Home
Modular Home
Footings_ Foundation Backfill_ Framing
Comments:
Yes No N/A
Foundation support, pier spacing,
Per manufacturer
Anchoring per manufacturer 2'from ends
Water line shut off
Sewer line support @ 4 feet
Heating Crossover[doublewide}off grd.
Dryer vented outside
Skirting ventilated 1 so.ft.per 1,500 sq.ft.
Hot water relief valve piping outside
Deck,porches, steps, railing
Fumace/hot water operating
Garage Fire proofing
Fire Door/Door closers
Plumbing Fixture/3"Vent through roof[Modular]
Foundation insulation [if applicable]
Smoke/Carbon Monoxide Detectors/Interconnected
Final Electrical
Variance required
Data Plate okay
Manufactured HUD seal okay
Warranty Seal after January 1,2006
/;;::'(\\,
Installers Warranty Seal (✓
18"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.I Perm.]
Model# Serial#
Manufacturer
Date of Manufacturer
L:1Pam Whiting120101Building Codes Forms\Manufactured_Modular Final Inspection_03 04 10.doc
Queensbury Building & Code Enforcement — Manufactured / Modular Final Inspection
Office No. (518) 761-8256 �- Arrive: am/pm Deparl3` am/pm
Date Inspection request received: 7 l, / Inspector's Initials /,4..�
_ � JJll
NAME: 1►iEcC �/1�7' L_ PERMIT#: Cl� -,1,1 .2
/ 1/)11• s c1ki 7
LOCATION: 74 `�, " T DATE: /AWL I
Manufactured Home �r� '
gi
Modular Home 410)-7),L' 'rfj��,
Footings_ Foundation_ Backfill_ Framing
Comments:
Yes o N/A
Foundation support,pier spacing, /� , • 7
Per manufacturer C�" (e`T ` �
Anchoring per manufacturer 2'from ends ,____-
Water line shut off
Sewer line support @ 4 feet V
Heating Crossover[doublewide}off grd. 4/
Dryer vented outside
Skirting ventilated 1 sq.ft.per 1,500 sq.ft.
Hot water relief valve piping outside
Deck,porches,steps,railing
Fumace/hot water operating /
Garage Fire proofing /
Fire Door/Door closers
Plumbing Fixture/3"Vent through roof[Modular] /
Foundation insulation[if applicable]
Smoke I Carbon Monoxide Detectors I Interconnected
Final Electrical
Variance required
17 -2
Data Plate okay
Manufactured HUD seal okay
Warranty Seal after January 1,2006V;
i) /143
—5
Installers Warranty Seal ✓ `Wk., —
18"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 C/O[Temp./Perm.]
pp � W t Qn � ' -c 9 LA
Model# Serial#1, vl 0(e, t� 1 t-i 143
/471(1 l '—i OctiCQ
Manufacturer
Date of Manufacturer k.A
\74.7 kZ.
L:1Pam Whiting120101Building Codes Forms\Manufactured_Modular Final Inspection_03 04 10.doc
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