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2013-271 V-V Q (518) 161-8201 Q Ny 12804-5902 Godes (5(61-9)?U1.$256 ueensb"�`' � '142 Bay ROad, �� evelop� B ent" uilding COMMAXI� CCAj � a •�� 0 201 d• yVedn esda) Date issue • r�t�u�bex: sb PerrnitNu�b -Pee done as hO�' Y '.0.1c requested to b certify that .vhys is to d• has been compfete200 L�ZE 0002-001-0p0-0 00 34g'OOg- S23A.00_ Location' ,dumber: EAS vYLL�,Cjs �'P rrax Niap F QOvm U NSBURY By pccle�t Owner; PSC�LLA GRt7 zov licant' ied as a: App a be Occup cture Sri � nom--�oreemen phis stxu e In park the property Building�Code Mobile klam .�dT relieve n or ptrectoi of f Occupancy DOES site Plan Varia Ce' and a the Planning Bo Certificate for compliance rovals by Issuance of this ility It of app er of the res[) s a re, ov,n es d conditions a oche on ngB°rd Of A or ppeals• Z TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20130271 Application Number: A20130271 Taff Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: PRISCILLA CRUM 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 LP 4294 ROUTE 5 Mobile Home In Park $15,000.00 CALEDONIA,NY 14423 Total Value $15,000.00 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2013-271 169 ELMHURST DR. Mobile Home 14'x 76' to be moved from 62 White Birch Estates, Ft Edward $127.68 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,June 24,2014 (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 ueen ury; on ne 24,2013 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement ;. ..///.............. ...... OFFICE USE ONLY.\),..,-........,,.------- ,..; -----; + 3- +2unv zar/ a TAX MAP NO. PERMIT NO.� 3 DATE ISSUED: PERMIT FEE ;E.�APPROVALS: ZONING TOWN CLERK Stamp MOBILE HOME-APPLICATION FOR PERMIT: -'- A -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 ProA tfiy Owner Information :590A Name. oir C_ _"a Address:D A WV Q�,L� ddress: "�i14 _) Ti Phone No. N 3 Ai �A41 6 -:I' JaAone No. Parcel Information Proposed Date of Placement: r , Property Location: /D '�P Z//r/kr-5¢ 4p/- Road,Street,Avenue Name of Mobile Home Park:/-/4) -/A applicable) Tax Map Number. f 2-2 2 . Mobile Home Information = Zonjgg nformation Approximate Value of Home:$leo Zoning Classification: / - New Home: ❑Yes X]No Size of Property: -ft.by ft. Replacement Home: D.Yes El No ; Existing buildings: A6/l/L� Size of Mobile Home: q, ft by ft Setbacks: front yard 20 ft. rear yard %5`ft. side yards_,e ft.and _ft Singlewide: _ Doublewide: Number of Rooms:(exclude baths) Accessory Building(s): Number of Bedrooms: — Number of Bathrooms: _ Detached garage: 1_car F-12-car F-1car ❑Gas Fireplace E]Woodstove p ❑Wood Fireplace Attached garage: [-car El2-car Elcar Foundation Support: Storage building: ❑Yes No Type Size & Depth Other. Piers Water Supply. ❑Well ❑Municipal _ Runners Slab Is Septic Permit Required? ❑Yes M No 4Confinued on page 2 M Town of Queensbicrly• Community Development Offce- 742 Bay Road, Queensvury,iv x Ll-.Du* Name of Installer or Mobile Home Dealer: Address: nelu 7 Phone: �- Complete information below found on a"Plate"or"Sticker"which is affixed to the mobile home: ✓ Insignia serial number:/y7r4 ® 11//0 4/7 ✓ Name of manufacturer: . ✓ Plan Approval Number: ✓ Model or Component Designation: (New home only) ✓ Date of Manufacture: �as.saw•:r:-:az.._z_._�........:.....:esr:n::asrsrrr:r:n:r.::r:-.ax:.nrrrsr..r>•sa:r:rr:r:na�-:v:r:rs:n:r.::r:r:ry— c AFFIDAVIT y J .. J � V Town of Queensbury State of New York c County of Warren + J I swear that to the best of my knowledge and belief the y statements contained in this application, together with the plans s 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 proposed work shall be complied with, whether specified or not, and that such y work is authorized by t wrier. s � M Signature: �t Owner,Owner's Agen,Architect, Contractor s V N J ✓...-.t—u-----------.r.r.s.-s✓✓—..r.r.r--.ru---:r✓------:r.s.s.r-----r:r.---� SPECIAL CONDITIONS OF PERMIT By: Code Enforcement Officer NV`Town.of Queensbunj• Communitij Development Office • 742 Bay Road, Queensbury, NTY 12804 � B - 3 Queensbury Building & Code Enforcement-- Manufactured / Modular Final Inspection .s� r Office No.(518)761-8256 Arrive: am/pm art:L " am/pm Date Inspection request received: Inspector's initials: NAME: 0, r V_ N\ PERMIT#: 13"a LOCATION: ! (O q 12A vv\�) I.I.r-s+ DATE: Manufactured Home Modular Home Footings_. _Foundation_ Backfill_ Framing_ Comments- Foundation support,pier spacing, Yes No WA j C da* tJV� Per manufacturer 3O Q m-% Anchoring per manufacturer 7 from ends Water line shut off' Sewer tine support @ 4 feet Heating Crossover[doublewide)off gni. Dryer vented outside Skirting ventilated 1 so.ft.per 1,500 sq.ft. Hot water relief valve piping outside Deck,porches,steps,railing Furnace/hot water operating Garage Fre proofing Fire Door/Door closers Plumbing Fixture 13'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 C/O[Temp./Perm.] l-w- , Model# Serial# Manufacturer Date of Manufacturer — — LAPam Whiting120101Building Codes Forms\Manufactur+eri Modular Final Inspection_03 0410.doc Queensbury Building & Code Enforcement— Manufactured / Modular Final Inspection Office No.(518)761-8256 Arrive: am/p De 2,1_, am/pm Date Inspection request received: Inspector's Initials: NAME: G rLA--M PERMIT* LOCATION: ' L&�T Q-G th ,(' DATE: J Manufactured Home Modular Home Footings— Foundation_ Backfill_ Framing '161) aooAs P0� Co=rm s• Yes No WA Foundation support,pier spacing, Per manufacturer oA Anchoring per manufacturer 2'from ends Water line shut off Sewer line support @ 4 feet ��L�� Heating Crossover[doublewide)off gni. Dryer vented outside Skirting ventilated 1 sa.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 rd 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 C/O[Temp./Perm.] j2F Model# Serial t# Manufacturer L64�,�,,� Date of Manufacturer Liam Whiting\20101Building Codes FormsWlanufactured Modular Final Inspection_03 04 10.doc Queensbury Building & Code Enforcement— Manufactured / Modular Final Inspection Office No.(518)761-8256 Arrive: am/p pa l�/- am/pm Date Inspection request received: Inspector's Initials: NAME:. a ' , ' PERMIT* 3 LOCATION: /U C� , C�a e e[---� DATE: Manufactured Home i 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 so.ft.per 1,500 sa.ft. Hot water relief valve piping outside Deck,porches,steps,railing Fumace/hot water operating Garage Fre proofing Fire Door/Door closers Plumbing Fixture/3"Vent through roof[Modular] Foundation insulation[d applicable] Smoke/Carbon Monoxide Detectors/Interconnected Final Electrical Variance required Data Plate okay Manufactured HUD seal okay V 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 C/O[Temp_/Perm.] Model# Seria!# - . Manufacturer Date of Manufacturer L:1Pam Whiting1201016uilding Codes FonmsWanufactured Modular Final lnspec tion_03 04 10.doc