2012-469 TOWN OFQ UEENSBURY
•
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120469 Date Issued: Monday, October 29, 2012
This is to certify that work requested to be done as shown by Permit Number P20120469
has been completed.
Location: 200 LUZERNE Rd
Tax Map Number: 523400-309-009-0002-001-000-0000
Owner: HOMESTEAD VILLAGE L P
Applicant: BRUCE & LINDA LAFOND
This structure may be occupied as a:
Mobile Home In Park 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 f�
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
(EL 742 Ray Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120469 Application Number: A20120469
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: BRUCE& LINDA LAFOND
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. Tyke of Construction Value
Owner Address: HOMESTEAD VILLAGE L P
Mobile Home In Park
4294 ROUTE 5
CALEDONIA,NY 14423 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2012-469 118 Adirondack St.
Mobile Home 16'x 80' Commo 1996 Model#880ZA
$153.60 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,October 18,2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Thursday,October 18,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
I , r ,
OFFICE USE ONLY
TAX MAP NO. PERMIT NO. I eD 4/ (ii 1 DATE ISSUED: ' i REQ EINE 1P
PERMIT FEE! `----- APPROVALS: ZONING TOWN CLERKt+a21.41:R
I
2
TOWN OF
Y
OING OFFICE
MOBILE HOME -APPLICATION FOR PERMIT:
A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a
valid building permit has been issued.
Ap licant Information Property Owner Information
Lf ame:tj rvc L4 Q r c Name: (VI L t rvx _
Address: Address: 1305 2..F
CA .cion i I tA) i i (-1 W i Li
Phone No. Phone No. ( 5j'g) ,21,,, - cf‘z40
Parcel Information £x f 3/y
Proposed Date of Placement: 5 Oi 7 %� Property Location: /fB, / d k 5i--
/ _ Road,Street,Avenue
Name of Mobile Home Park:dr:M•eS _1k/6144fif applicable) Tax Map Number: SiO�• ?-2.
Mobile Home Information Zoning Information
Approximate Value of Home:$ Zoning Classification:
New Home: ['Yes [ ,No Size of Property: JP.3 ft. by /2Oft.
Replacement Home: VIYes ❑No ), v'CT Existing buildings: No/VP...
Size of Mobile Home: /6 ft. by 8a ft. 1 Setbacks: front yard aO ft. rear yard 1. ft.
side yards /0 ft.and /0 ft.
Singlewide: Doublewide:
Number of Rooms: (exclude baths) Accessory Building(s):
Number of Bedrooms:
Number of Bathrooms: Detached garage:❑1-car ❑2-car ❑ car
❑Gas Fireplace 0 Woodstove 0 Wood Fireplace Attached garage: ❑1-car n 2-car ❑ car
Foundation Support: Storage building: nYes L No
Type Size & Depth Other:
Piers
Runners Water Supply: IIIWell ®Municipal
Slab Is Septic Permit Required? ['Yes Fallo
Continued on page 2
Vey Town of Queensbury• Community Development Office • 742 Bay Road, Queensoury, iv r l,zouf
Name of Installer or Mobile Home Dealer: ; l7 , /11)2
Address:9X'/�„4�7r/l*7p 0 Phone: 3/S 7q 2-
Complete information below found on a"Plate"or"Sticker"which is affixed to the mobile home:
✓ Insignia serial number: Set O mroa i-
✓ Name of manufacturer: 6)9iz ez-r AeP
✓ Plan Approval Number:
✓ Model or Component Designation:
971e,^� (New home only)
✓ Date of Manufacture:
4.!i'i:':!i.:.....:......:i!:!�R!:!:`:!1_•L!:!:!:!:!LK!i!L!i!:Y.!:!LY.:i•:!.:^.!ili!i!::!:!:!i!i i.i!..._.!ttt_i_L_'i_i_._i 1�
AFFIDAVIT
Town of Queensbury State of New York
County of Warren
4
C G
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
s
that all provisions of the BUILDING CODE, the ZONING
ORDINANCE, and all other laws pertaining to the pr.•---:- ork
shall be complied with, wh- er s•-.Tied or no h. suc
z work is authorized by the o. 4
ti
Signature:
` Owner,Owner's Agent,Architect, Contractor
r �
.�i:�:r.r.i.�✓.�.r..r.r.�..'.t.�✓:�.�✓.r....�✓.1✓✓✓:�..v�✓.r.r.r✓✓✓.r✓.�.r..r✓:i...:�✓:�✓.�✓:�.�.-s..r:�:�✓✓✓:s✓✓✓.�
SPECIAL CONDITIONS OF PERMIT
•
•
Code Enforcement Officer
Town of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804
�l • '�,= -
Queensbury Building & Code Enforcement — Manufactured / Modular Final Inspection
Office No. (518) 761-8256 Arrive:
am/pDe : l Z am/pm
Date Inspection request received: Inspector's Initials:
NAME: kat_ Fc7c�
�j PERMIT#: � � b /
LOCATION: (L€',, DATE: ( Il
Manufactured Home PC
Modular Home
Footings_ Foundation_ Backfill_ Framing
Comments:
Yes No WA
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 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 losers
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 I
Okay to issue C/C or CIO[Temp./Perm.]
Model# f rL..5-�� 8� Serial# l � )
Manufacturer •
Date of Manufacturer _.7) L2� ��
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 Depart:1. , ) am/pm
Date Inspection request received: Inspector's Initials: C ;JA—) �
NAME: j-. Ai; i'cJ PERMIT#: / ,�� cI 9
•
LOCATION: / / :4 ri 1 ;-c: 11ctrq.0 K J+ DATE: / 6 --,4 `1-1
Manufactured Home f141' M ,,S - ci<ri
Modular Home
Footings_ Foundation_ Backfill_ Framing—
Comments:
Yes No N/A
Foundation support, pier spacing,
Per manufacturer
Anchoring per manufacturer 2'from ends ,/>'
Water fine shut off V
Sewer fine support @ 4 feet
Heating Crossover[doublewide}off grd.
t7
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 j
Garage Fire proofing 7
Fire Door/Door closers
Plumbing Fixture/3"Vent through roof[Modular] //:
Foundation insulation[if applicable] i/
Smoke/Carbon Monoxide Detectors/Interconnected ,✓
Final Electrical v�
•
Variance required
1 Data Plate okay
Manufactured HUD seal okay
Warranty Seal after January 1,2006 ✓
Installers Warranty Seal / IJ.g /'
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.I Perm.]
Model# Serial#
Manufacturer
Date of Manufacturer
L:\Pam 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 Depart /"A''' am/pm
Date Inspection request received: Inspector's Initials:
' l
NAME: LCL rem al PERMIT#: 1 ,9 — <f(1 9
LOCATION: /1 Y -4-6Lu —(i, iq 6 K DATE: /0 —:&3—Lz__
Manufactured Home ,/ Mt
Modular Home
Footings_ Foundation_ Backfill_ Framing
Comments:
/No N/A
Foundation support,pier spacing,
\k
/
Per manufacturer
Anchoring per manufacturer 2'from ends Y r _-, A 1,N;,--
; Z`v 7✓ '�
Water line shut offJV` ��7
Sewer line support @ 4 feet Z
Heating Crossover[doublewide}off grd. fl;
Dryer vented outside ✓
Skirting ventilated 1 so.ft.per 1,500 so.ft. V
Hot water relief valve piping outside ,�
Deck,porches,steps, railing
Fumace/hot water operating
Garage Fre proofing . f
Fire Door I Door closers V
Plumbing Fixture/3"Vent through roof[Modular] V
Foundation insulation[if applicable] V
Smoke/Carbon Monoxide Detectors/Interconnected
Final Electrical 1
Variance required / ]t (;�(st31`M•;— "
Data Plate okay
Manufactured HUD seal okay �` / � � -5P
Warranty Seal after January 1,2006 - C/
Installers Warranty Seal V
18"x 24"access or 22"x 30"attic access V
Vapor retarder under home 6 mil poly or other
911 Street number
V
Okay to issue C/C or CIO[Temp./Perm.]�I -
Model#13 A Serial#
Manufacturer 6.�*.M-LJ
Date of Manufacturer tielL
L:1Pam Whiting120101Building Codes FormslManufacturedModular Final Inspection_03 04 10.doc
Queensbury Building & Code Enforcement — Manufactured / Modular Final Inspection
Office No. (518) 761-8256 Arrive: am/pm Depart G.i -'am/pm
Date inspection`request received: Inspector's Initials:
NAME: h.l :\C3,6L-k--BC-1,tc e 1-,( Z)f)d PERMIT# a "Ki/o
LOCATION: N1 �'S'k J I I g c(I 9ATE: /0 / -) -�
Manufactured Home "�I�
Modular Home
Footings_ Foundation_ Backfill Framing
Comments:
Yes No NIA
Foundation support,pier spacing, f) f\i\f c I
Per manufacturer
Anchoring per manufacturer 2'from ends
Water line shut off cr
Sewer line support @ 4 feet
Heating Crossover[doublewide}off grd.
Dryer vented outside I ( ��
Skirting ventilated 1 so.ft.per 1,500 so.ft.
Hot water relief valve piping outside
Deck,porches,steps,railing
Fumace/hot water operating '\4(:-RA �h 2
Garage Fire proofing --
Fire Door/Door losers
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 CIC or CIO[Temp./Penn.]
Model# Serial#
Manufacturer
Date of Manufacturer
L:1Pam Whiting\20101Building Codes Forms\ManufacturedModular Final Inspection 03 04 10.doc
INSTALL NO. 17889 STATE OF NEW YORK
DEPARTMENT OF STATE
. ONE COMMERCE PLAZA
!l' ,;`'h 99 WASHINGTON AVENUE
ALBANY,NY 12231
INSTALLER'S WARRANTY SEAL
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE
0 NEW MANUFACTURED(HUD CODE) 52 RELOCATED MANUFACTURED(HUD CODE)
A. Manufacturer's name: ait1olesPp12,1.
B. HUD label number: PM en 7YY Serial number: £Utotrtoa19 PC 33 i
C. Retailer's name:
D. Retailers address:
ilV A(el Mout
E. Retailer's certification#: Telephone#:
t
r F. Installer's name: /) Qt411 C/ ( 1 fs3
G. Installer's address: 91 D.4.164,12,96 6La./S, Y Ade ,&J 'f
H. Installer's certification#: / Z.v T/)t779 / Telephone#: w!v�7 R aS'73-c
I. Date installed: /r1��f/o Municipality issuing building permit: a,,c (t.,dl[sQY
(City,Town, Village)
J. Customer name and physical address (911)where home is installed: /3/2'l. //a' ,/Ida.. 5r-
44.40-641.qur ,New York. /ore /
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, fether contractually or by operation of law.
Printed Name of Person Signing Seal: /4.964RiCe c p
Signature of Installer or
Limited Installer: 4;4 " '
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 11/05/2012 14.42 518 273 1202 P.005
'. •Nov, 5. 2012 2:41P �:.;�•;MDIA, Watervliet NY•,.•., .' ,-. .�:vs.is s i.s, ist:No. 6691 • 'P. 5/6\ w
til • ._._._._._... .._1_,,_. kis _ _ '_ 0,J0,.•/Dlt,/.V&.\!tU.x.J.,,._,,d\ J.✓.L%� k! \�_. tf�Qi�A.04--4
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
c(1-) i
�erhAA that the electrical wiring to the electrical equipment listed below has been examined and is approved as '•sf
i. beingin accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date �Y
C'•) 7�r
. noted below and is issued subject to the following conditions.
t:
1.
:` Owner: Bruce Lafond Date:
0 10!1912012 7
`/1
0 7
ti
Ti,ki
Occupant: Same Location Adirondack Street Lot 1
8t
0Queensbu
��e�� Occupancy: Single Family Dwg. QueensburyWarren Co. NY <<•^j
•
r —I el---- el,
Applicant: Bruce Lafond
PO Box 935 �. ;i: '1,,,, . • .,.
(raj Milton VT 05468 ,..... _ �
C4
4.K,
•
j
l'4 Joseph A.Holmes ,i.: •-;: :•, - ; ::.t••:, :. „:,;•
318014'1.4 834 • �'; • °•'" •
tC�
•
Equipment: :,,. •.- :;. :: P :.:
' -;••••••:.. .,::::.:::',7;1,::-•:,.;,A.:.-.�tl
, 1 - 100 Amp Feeder To Home • - • • •V. . = .
09.
cY )
I . :•fix: ..
,�•
= c�) •
v
kill
*ig This certificate applies to the•electrical wiring to the electrical equipment listed immediately null and void. This certificate applies only to the use.occupancy and WC
. above and the installation inspected as of the above noted date based on a visual ownership as indicated herein. Upon a change in the use,occupancy or ownership
(til Inspection. No warranty is expressed or implied as to the mechanical safety,elli. of the property indicated above,this certificate shall be immediately mill and void. '%fir;
• ciency or fitness of the equipment for any particular purpose. This certificate shall In the event that this certificate becomes invalid based upon the above conditions,
.).t.,./.
� be valid for a period of one year from the above noted date. Should the electrical This certificate may be revalidated upon reinspection by Middle Department �'
`� 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 c
(}) ed to•the introduction of additional electrical equipment and/or the replacement of Department inspection Agency, Inc. to initiate the inspection and'revalidation y
((��I'�. any 01 the components Installed as of the above noted date,this certificate shall be process. A fee wilt be charged for this service. t-�.`)
•� '• �•1:••.a, :��::�.F.;V- . •`%:��i.\:! R15 `�i.� �•i^Vr \�::0--N.7 'l ,s•v "\S ,•,vim — IA
3 �� i:v:�✓: ✓ S, .�. ,J�.�.`����� w. ir1�' �" r r :�•�S- R,T �F��-.ri.�:i: ��> `"i'"i;��:?i•�; "r%"(:.vio�yn,�,�. nv i��
.'•`.\,.L.,!�:.r•!.,S�'..�.�.,• .�`✓',' �•`.�!�V'l:,-';.y,r e ai'•:,? .)r;yr•'y.ni.aii•• .c : ..,i.y (' i"�'� .•.., I.I. ti•A
, Rot ?Lan 3c4E : I "= !o '
-?
/ 7 RECEIVED
,
L )
ysEp 2 4 2092
TOWN OF QUEENSBURY
/ ZONING OFFICE
•
7 .[ / / b
M
, .,
Pp
. i!:-- . \, ., ..,
,:- -. Y
/ iY v 1%
/IIm`
I %.
j:'
1 1y.7
,
,,,,, • (_,.., .
(..,----) .
v=
o
o
/
I -0
N co
i ,/ a3)
V v ii o
c
f 0
T Ti. v
Q 0.J
Cr-� • -
PE' 1T P -
-�---LOQ • � � �.
I HAVE PERSONALLY MEASURED THE B fi C!E { '"
:• � TP -
HE •�-
RTY LINES Q
PRO •S • RUC RE(S)OR SIGN(S)
-4 \ '-t•-• .• —
IGNA '--RE -al'
A 1
Road Name: d ` vi 1
_..... - , /0/ //6946/(nrazic/<
HOrnEts,TEAd A7/L GE
5112 5 ; '21:34e'.3 323130 29 ?$ Z/ ze
• 4 I .2•--- 5- f-
p uotliA Ell, d-L-11 Ell 130 5 83 •_ . .E2: 35 .Z1
YL a_ _153 13111.12
' 13 •.i . 1,29 g1 '$ 31 23
. Z. _ 1 '851 - 80 37 kZ 1
,..1\
`�t� .. .149 12S 88 `-' I77 I :40 ° 1.5 i
- YrIL4B- 1.3 ``r -' Ila 4g
4.b8, .-. 8 /;: :.L23 r-5,. -c _ ?3 12 i6;� ..7
10 .. (II1.1{�• 13i 122 al 79 -4 3 - 1to
. _zoo , �s 1419 is , .52
Fn� • !;44 3,. .
•
Ili . C1• ' r' 191 .L-f.El ' 9 3 '72 .45 ....zt -
Es 2fi5' '14Z , 1.19 a1 ,..o t, _ I a.'S `
47 - ,
4
{. i ,.ems r-Ti-l-18. . 1 5 V '41
- f 2Q1Z
X79 ' 9b ��9 $ - TO•
• I ' _1� • 97. r ta$ { �9 + ! 1 Z.'►�.TT,a EENSBURY
I OFFICE
g: I ' ,i S CO., :p • 107 ;� g I
t44' I r� �I 9q? i4 • !ate s� " S
do ill
41 f 9.7 p :.113 ••.loci Z Ens
r
•
..9' - ji7MdJ3.Z 101. F L� E 3 m :�
;i:z .x•80 • .11 %11i_ 4 1111,
=0? tai i ,� , 5
- ;Ft .1.81.-_ ' ,,'17-0 I N1 ° �z� �S I - -
el • ! 1ST j l '-i La k . Ilall1
1,
-
A7 vim°; 8
_ i -1J t EU
11.
RECEIVED
SEP 2 it 2012 -1
TOWN OF QUEENSBURY
ZONING OFFICE
ki
A