2013-563 TOWN OF QUEENSBURY
742 Bay Road,Quecnsbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20130563 Date Issued: Tuesday, December 31, 2013
This is to certify that work requested to be done as shown by Permit Number P20130563
has been completed.
Location: 78 MONTRAY Rd
Tax Map Number: 523400-296-014-0001-007-000-0000
Owner: GRAYSON PROPERTIES LLC
Applicant: MICHELLE TUCKER
This structure may be occupied as a:
Mobile Home In Park By Order of Town Board
ka+cls TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property ( „J.), p /A.,_
��
owner of the responsibility for compliance with Site Plan, Variance, or
other issues and conditions as a result of approvals by the Planning Board Director of Building& Code Enforcement
or Zoning Board of Appeals.
0.ik TOWN OF QUEENSBURY
.404 .
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130563 Application Number: A20130563
Tax Map No: 523400-296-014-0001-007-000-0000
Permission is hereby granted to: MICHELLE TUCKER
For property located at: 78 MONTRAY 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: GRAYSON PROPERTIES LLC Mobile Home In Park $10,000.00
1004 CHESTNUT St Total Value
MECHANICVILLE,NY 12118 $10,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2013-563 lot 20
Mobile Home - 1984 Commodore, Model 17003, Serial #CJ9448A
$110.88 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,December 10, 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�f Que sbu 4T t 1 : • ember 10,2013
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
MOBILE HOME APPLICATION Received: 5I r3 t', 2�13-
Tax Map ID:-- Ace&., 1 q - i--
A permit must be obtained before placement of mobile home on parcel. No Permit No.: / —5�o
inspections will be made until a valid building permit has been issued. Permit Fee: $ l/D, $ S
Applicant A,J .1 " 7:-/--e:�' Property Owner2. .i Vii/ !�/�_// i _ L•
Address G�y � , Address
,12).t �d
Phone '7.q, --- / 4/ Phone . �A q A
Contact Person for Building&Code Compliance: Day Phone:
Name of Installer or - Proposed Date of Placement
Mobile Home Dealers Name of Mobile Home Park ?�?G � A:
Address q, !' 49 4(L. IL /a Property Location � �
Phone '7 Q .R 0 /7 58 Tax Map ID 25k0 - 19 - 1 -1
Complete information below found on a "Plate"or"Sticker"which is affixed to the mobile home:
• Insignia serial number: C \-\`',k
• Name of Manufacturer: C__C)aNki,-NU\ V,E
• Place Approval Number:
• Model or Component Designation: \—1(-)0_ (New home only)
• Date of Manufacture: \UA\Z BN-A
Mobile Home Information Zoning Information
Approximate Value of Home $ /p es o U Zoning
New Home or Replacement 'l ' LCi' Size of property ft. x ft.
Size of Mobile Home /4/ ft.by ft. Existing Building(s) e),3 y .Y),Pt.Y), Ho 6 i S n
Singlewide or Doublewide „diA4/ �� / /;?e, Accessory Bldgs.
4/
(exclude bath) v Storage Building(s)
Number of Rooms �/ g g( )
Number of Bedrooms o2 Detached Garage _1 car _2 car _3 car
Number of Bathrooms Attached Garage _1 car _ 2 car _3 car
Gas Fireplace Setbacks Front Yard: feet
Woodstove Rear Yard: feet
Wood Fireplace Side Yard: feet
Foundation Support Size Depth Water Supply Well f/
�/
Piers Municipal
Runners Septic Permit Required?
Slab tiC)
Town of Queensbury Building&Codes Mobile Home Permit 518-761-8256
Procedure for placing and occupying a mobile home or modular home:
1. Application is submitted and reviewed: 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 the Town's website
5. Septic Inspection, if needed
6. Final Electrical Inspection
7. Stairs and 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 sited 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-
$10.00; Deposit-$100.00(refunded when all items are complete)
✓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 of the 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.
Print Name: NA R_ LA-C-��
Signature:
Owner,Owner's Agent,Contractor
Date: t )_ - - Zv \. 5
Special Conditions of Permit:
By: Code Enforcement Officer
Town of Queensbury Building&Codes Mobile Home Permit 518-761-8256
Queensbury Building & Code Enforcement — Manufactured / Mod -r Final Inspection
Office No. (518) 761-8256 Arrive:C • . ••• q part: o-o" a
Date Inspection request received: Inspector's Initi- - ,Al
NAME: PERMIT 11.- 1 7-) " tilt-3
LOCATION: N1 G+JTRA`i r Z.L; DATE: I Z - 3\ —
Manufactured Home
Modular Home
Footings_ Foundation Backfill_ Framing_
Comments:
_ Yes ' N/A
Foundation support, pier spacing,
Per manufacturer
Anchoring per manufacturer 2'from ends
Water line shut off
\k///)
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 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 �v
18"x 24"access or 22"x 30"attic access
Vapor retarder under home 6 mil poly or other
911 Street number f
Okay to issue C/C or CIO[Temp./Perm.]
Model# Serial#
Manufacturer
Date of Manufacturer
L:\Pam Whiting12010\Building Codes Forms\Manufactured_Modular Final Inspection_03 04 10.doc
Queensbury Building & Code Enforcement— Manufactured / Modular Final Inspection
Office No. (518) 761-8256 Arrive: - i- � T'� -► -
p
Date Inspection request received: Inspector's!nit �.
NAME: r��G N`1'� —��\�L -1 t��,( PERMI '
LOCATION: 1 Ljiv DAT'
Manufactured Home
Modular Home /5/
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 sq.ft.per 1,500 sq.ft.
Hot water relief valve piping outside
Deck,porches,steps,railing
Furnace/hot water operating
Garage Fire proofing
Fire Door/Door losers
Plumbing Fixture/3"Vent through roof[Modular]
Foundation insulation[f applicable]
Smoke/Carbon Monoxide Detectors/Interconnected
Final Electrical
Variance required
_ U
Data Plate okay �? �v
Manufactured HUD seal okay 1/ •�\ �C^ ��
Warranty Seal after January 1,2006 \v�/
Installers Warranty Seal `�
18"x 24"access or 22"x 30'attic access /
Vapor retarder under home 6 mil poly or other
C°K.
911 Street number -
05?
Okay to issue CIC or CIO[Temp.I Perm]
Model# 1----7-ic51:5-7i Serial# )
ManufacturerC_ 11 mL,
Date of Manufacturer \ZA\
\
L:1Pam Whiting120101Building Codes Forms\Manufactured_Modular Final Inspection_03 04 10.doc
Queensbury Building & Code Enforcement— Manufactured / Modul. -Final Inspection
Office No. (518)761-8256 Arrive: 1 .1 aj
i-part: '-1,041gro
Date Inspection request reeiived: Inspector's Initials: , `
-
NAME: 1—
U�G 1'1 aR PERMIT#: 0.)—" 6.
LOCATION: ' 7*STRPI'l (-) UT2 0 DATE: \ Z-— TA—\-7-)
Manufactured Home
Modular Home
Footings Foundation_ Backfill_ Framing
Comme nts:
Yes No N/A
Foundation support, pier spacing, / (,r�T 11I V)
Per manufacturer /� - 1_- _-CI RAC.A:\\.- ON.."C L.E 1 N
Anchoring per manufacturer 2'from ends ,M S'•57- C-6 �Qc \ E` c; ;?�.
Water line shut off
/ E-L‘_ -?-- -\") `� ����`W )E '
Sewer line support @ 4 feet
Heating Crossover[doublewide}off grd_ 1.iiii
I _ Q a�T\\ P,( \N-5-C----
Dryer vented outside � Q ,Skir#ing ventilated 1 sq.ft.per 1,500 so.ft. C \16 ��•�� TDHot water relief valve piping outside (=R--- ��� �
Deck,porches, steps,railing
Fumace/hot water operating / - , .� - 1, _7��
Garage Fire proofing v j` _ ```'f
Fire Door/Door closers , / ��L�� •ce'iZ \�;7�-�Lp k
Plumbing Fixture/3"Vent through roof[Modular] J v l�\-1 ,6 'F-3�' _
Foundation insulation[if applicable]
Smoke/Carbon Monoxide Detectors/Interconnected Ji
Final Electrical Vt /
Variance required J
Data Plate okay4
Manufactured HUD seal okay
Warranty Seal after January 1,2006 J
Installers Warranty Seal yi
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_/Perm.] j
Model# ‘—rd Seriall# c_._--.,1 -i i-\\-\S f\
Manufacturer CO M V`-\C DORF
Date of Manufacturer \C - 1 Z- - 3L1-
L_1Pam Whiting120101Building Codes Forms\Manufactured Modular Final Inspection_03 04 10.doc
.
IN81ALL NO. 20242 STATE OF NEW YORK
p DEPARTMENT OF STATE
ONE COMMERCE PLAZA
; , : ., 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) ,RELOCATED MANUFACTURED(HUD CODE)
A. Manufacturer's name: `"--MO
B. HUD label number. 114 074149/ Serial number: CIT gyy.CA
C. Retailer's name: ll
i
rk,A tzia91-,t ( L �lc,U.E
D. Retailer's address:
E. Retailer's certification* Telephone#:
F. Installer's name: /YIALArI i/L!�
(....1.43.<
G: Installer's address: 96 i/H..4 tS / 110 at„fxwS/3c.t2Y r./?
H. Installer's certification#: / 1:ev cao'I9 I Telephone#: 3/? 79196-7•SJY
I. Date installed: /G/Iif 3 Municipality issuing building permit: ��.. sr3
(City,Too,Village)
J. Customer name and physical address (911)where home is installed: /Yf ICIV,E1 . }�ce.�/e1Z..
?do 7.roft s(i7gr 42 ai.. j i zy ,New York. /th51:041
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,wh�t�her contractually or by operation of law.
Printed Name of Person Signing Seal: /11.A. .RU.-.f "t
ilt-
Signature of Installer or
Limited Installer:
If you have a problem wi h 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
i
P-_ T RK PLS?TTLAN '
i I HAVE PERSONALLY MEASURED THE DISTANCE
FROM THE PROPERTY LINES TO THE
PROPOSED STRUCTUR,4(S)OR SIGN(S)
SIGNATURE DATE
0 1 Y5673
TOWN OFOUEENSBURY J ... • ,
- ,
BUII_rf.)1',.i DEPS T MEN -
Bas'd on our limited enrVicii-m,c�:n;i::'d fico
C'ii CU{ COMME,=1t :.,ill' nOi 'ie ^.; Gtrued as
;, pni{',1:aiicT afe in ill
full C� ?i,.nw ';!iti.. t BuI,d ..
�::u ue
t.e;,\.3,;,.C�_`.c. �.,
7 I _+
i
NOTICE .
ANCHORING OF MOBILE HOME
• FRAME IS REQUIRED PER •
MANUFACTURERS SPECIFICATIONS
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