2014-333 sat TOWN OF QUEENSBURY
vral
742 Bay Road,Quecnsbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20140333 Date Issued: Tuesday, September 09, 2014
This is to certify that work requested to be done as shown by Permit Number P20140333
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
TOWN OF QUEENSBURY
3 Windsong Drive
Issuance of this Certificate of Occupancy DOES NOT relieve the property < j�G
owner of the responsibility for compliance with Site Plan, Variance, or �J �'
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
`iia 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140333 Application Number: A20140333
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 $10,000.00
4294 ROUTE 5 Total Value
CALEDONIA,NY 14423 $20,000.00
Contractor or Builder's Name /Address Electrical Inspection Agency
MAURICE COMBS
96 VAN DUSEN Rd
OUEENSBURY.NY 12804-0000
Plans& Specifications
2014-333 3 Windsong Drive
Mobile Home in Park Habbertown Sprite Serial #08-L-55741
Liberty Home 3/18/1985
$86.40 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 29,2015
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbu efore the exp. tion date.)
Dated at the Town f Que n uu i • " u y 29,2014
-ssSIGNED BY for the Town of Queensbury.
Director of Building& Code Enforcement
c-
' .11 Town of Queensbury Building & Codes office Use duty
MOBILE HOME APPLICATION} fRecewed: �
1� 1`JL 2 E < ID: .CUD4, 47- a-_]
A permit must be obtained before placement of mobile hie on parcel. No .
Permit6N •y I /—33�
inspections will be made until a valid building permit ha"s beenissued.OF `FRemit:Fee: $ g 6 ,CO led
-,1,1/1 /l BULL 19 x `1vv. ` '
Applicant (Asa Property Owner 14cma54eAcl Vt.I(Aj-e-.
Address /0 7' .&rr9O y/t-e- AVC Address y Sk-, a+. S
l tkinrd, .c/Y in?k- 0lAS_AonIA ,M`t' 1Lig 2-3
- Phone 75/4 -61/9 ce//- 9q c--7`/tO Phone (516 ) fl/c -(/S"O
/ E + 3/y
Contact Person for Building&Code Compliance: ,2o/rri MO/elite Day Phone: S-675--305 Sett 1
Name of Installer orProposed Date of Placement ��/ /
Mobile Home Dealer/WVl (fes R4-o 5 Name of Mobile Home Park 4„,19 1L.i '
Address % vim alien /<.1 oscy /24v1 Property Location _ /' 7. Os , Zia
Phone 7902'3758 Tax Map ID < `9' 2 - /
Complete information below found on a"Plate"or"Sticker"which is affixed to the mobile home:
• Insigniaseraly
7 /
• Name of Manufacturer
• Place Approval Number:
• Model or Component Designation: (New home only)
• Date of Manufacture: ',EC-
Mobile Home Information Zoning Information
Approximate Value of Home $ /0,op o Zoning
New Home or Replacement ^''7"/qcizmen Z- Size of property 53 ft.x /20 ft.
Size of Mobile Home /p2 ft. by_,O ft. Existing Building(s) /go A..12_
Singlewide or Doublewide Si"5 (it Accessory Bldgs. h -
Number of Rooms(exclude bath) S Storage Building(s) ,
Number of Bedrooms a Detached Garage _1 car _2 car _3 car
Number of Bathrooms / Attached Garage _1 car _ 2 car _3 car
Gas Fireplace Setbacks Front Yard: (2O feet
Woodstove Rear Yard: 1ST feet
Wood Fireplace Side Yard: It feet
Foundation Support Size Depth Water Supply Well
Piers Municipal X
Runners Septic Permit Required?
Slab MO
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)
✓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 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: " r, c t 14. L . -
Signature:
Owner,Owner's Agent,Contr.• or
Date: frS."7/,
Special Conditions of Permit:
By: i.. /� Code Enforcement Officer
Town 4 Queensbury Building& •e Mobile Home Permit 518-761-8256
I' ht-t+s Ic -ia
Queensbury Building & Code Enforcement— Manufactured I Modular Final Inspection
Office No. (518)761-8256 Arrive: am/ atATTI /5[C'm/ pm
Date Inspection request received: Inspector's Initials:
NAME 4 PERMIT* / — 33 3
LOCATION:
L 1 A.)iNt\ i'i0�/`� DATE:
Manufactured Home (V Ui
Modular Home
Footings_ Foundation_ Backfill_ Framing_
Comments:
Yes No NIA
Foundation support,pier sparing,
Per manufacturer
Anchoring per manufacturer 7 from ends
Water fine shut off
Sewer line support @ 4 feet
Heating Crossover[doublewide}off grd.
Dryer vented outside
Skirting ventilated 1 sq.ft.per 1.500 sa.ft
Hot water relief valve piping outside ,{,
Deck,porches,steps,railing
FumaceJhot water operating
Garage Fire proofing .
Fire Door/Door closers
Plumbing Fixture/3'Vent through roof[Modular]
Foundation insulation[ff 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 2Y x 30'attic access
Vapor retarder under home 6 m0 poly or other
911 Street number
Okay to issue CIC or C/O[Temp./Penn.] .;W
....._Ip...„... 1„r
Model# Serial IV_L
Manufacturer
Date of Manufacturer
L:1Pam WhiIing120101nuilding Codes FomusManufactured_Modular Final Inspection 03 04 10.doc
1-INTALL NO. 209 4 5 STATE OF NEW YORK
DEPARTMENT OF STATE
Ye ONE COMMERCE PLAZA
cc,C T-0_ 99 WASHINGTON AVENUE
ALBANY,NY 12231
INSTALLER'S WARRANTY SEAL
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE
❑ NEW MANUFACTURED(HUD CODE) %RELOCATED MANUFACTURED(HUD CODE)
A. Manufacturer's name: /C.//3f.[/Y
•
B. HUD label number. giro 'jibe? Serial number. Db-C-an/
C. Retailer's name:
D. Retailer's address:
n/J4 lVhr,,a eros
E. Retailer's certification#: Telephone#:
F. Installer's name: /H8'..ehf1�� �/a"
G Installer's address: 94 cars'� i✓ 62.aii..&. c- 4- k!� /Oho"'
H. Installer's certificate n#: /S,.. r X179! Telephone#: f/k' VWS7S F
I. Date installed: fri/� Municipality issuing building rermit: ✓1ow Y
,1 .. (City, , Village)
J. Customer name and physical address (91 where home is installed: o
d
ed0 L'et a. 3 _ loosi3r.rZY ,New York. /e of/
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,wyeU�er contractually or by operation of law.
Printed Name of Person Signing Seal: ALA//��/Gfi l/(-was
Signature of Installer erase,.
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
fu es /o —/.1Queensbury Building & Code Enforcement— Manufactured / Modular Final� Inspection
Office No. (518)761-8256 Arrive: am/pm DepartlV tL am/pm
Date Inspection request received:
� jj Inspector's Initials:
fi
NAME: "brttai Q 0A PERMIT#:854.4ff33 3
LOCATION: -3 (.J us.. pit,t,,c r. Nb JZ DATE: 9—a—/ y
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 V
Sewer line support @ 4 feet
Heating Crossover[doublewide}off grd.
Dryer vented outside ✓
Skirting ventilated 1 sq.ft.per 1,500 sq.ft r
zo
Hot water relief valve piping outside
Deck,porches,steps,railing `+//
Fumace/hot water operating /
Garage Fire proofing V f/
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 v 77---IS,-
7S�^• — OS
Warranty Seal after January 1,2006 31v�
Installers Warranty Seal
18'x 24'access or 22'x 30'attic access / _
Vapor retarder under home 6 mil poly or other / t/ mss
911 Street number V- ` `
Okay to issue C/C or 00[Temp./Penn.] V
Model# Serial# -L'–cc--ccIli
E2
Manufacturer kA o 1 en-31 � (.Cr,r�'45
Date of Manufacturer 3 110(i f
L1Pam Whiting120101Bulding Codes Forms\Manufactured Modular Final Inspection 03 04 10.doc
s
— TOWN Of QUEENSBURY
S BUILDING DEPARTMENT — - -- -
S Based on our limited examination,compliance
with our comments shall not be construed as
indicating the plans and specifications are in
full compliance with the Building Codes of
New York State.
.—__—
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Y
3
1 •
NOTICE
ANCHORING OF MOBIL HOME
FRAME IS REQUIRE PER
! c^ MANUFACTURERS SPEC1 (CATIONS
`, joinI
l (J TOWN OF QUF: S/�
I Reviewed By" A 1 ir_
Date:
p 1
U
•
rnAd% q-� �
Queensbury Building & Code Enforcement— Manufactured / Modular F.• -I Inspection
Office No.(518) 761-8256 Arrive: IV; 'fs`�►,',,. am/pm
Inspector's Initials:
Date Inspection request received: i" '
�
NAME: -ti4r i ta/� tr ,0 ta g.. PERMIT, J i-33 3
b
LOCATION: / I t\]We by l Il -A-0 E F=-I- DATE ��g
Manufactured Home J tJ � d
Modular Home I ,, �(l__
Footings_ Foundation_ Backfill_ Framing_ / t7�1— ((LS955— vat
Comments:
Yes No _WA_
Foundation support,
pier spacing, A CO ea 3 tJ l+�ason lA
Per manufacturer
Anchoring per manufacturer 2'from ends
Water fine 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/bot 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 HUD
d
Manufactured Hseal okay
Warranty Seal after January 1,2006
Installers Warranty Seal P
18'x 24'access or 22"x 30'attic access per`\�j' C)
Vapor retarder under home 6 mil poly or other c �Z� C— "�
911 Street number
‘7,
"7 j
Okay to issue CIC or C/O[Temp./Penn.] ^ //
Model# 1\Il�$ v�1 Serial# 657f4 1
Manufacturer Lt 3C2_ ( \* F
Date of Manufacturer
L-1Pam Whiling1201016uilding Codes Fonns\Manufactured Modular Final Inspection 03 04 10.doc
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ation: 3 tiyinc-(•selecl D2,
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