2014-494 TOWN OF QUEENSBURY
j 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20140494 Date Issued: Wednesday, August 12, 2015
This is to certify that work requested to be done as shown by Permit Number P20140494
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--45 WINDSONG DRIVE
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 ( n /� J�
owner of the responsibility for compliance with Site Plan, Variance, or
�d
other issues and conditions as a result of approvals by the Planning Board Director of Building&Code Enforcement
or Zoning Board of Appeals.
EE i� TOWN OF QUEENSBURY
14ta 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140494 Application Number: A20140494
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 $38,000.00
4294 ROUTE 5 Total Value
CALEDONIA,NY 14423 $38,000.00
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2014-494 45 WINDSONG Dr.
Mobile Home 924 sq.ft.
$110.88 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, October 08,2015
(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 TownQueegsb u q We e a 1 etober 08,2014
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
if .. �. -- _ . --�
`.: ! j S
Town of Queensbury Building & CodesOffice use(Only
u
IIII OCT� u7 2014 I
MOBILE HOME APPLICATION Received: U
Tax Map ID: TOr., i .' lg.;- .S.' JRY
V BUiLI,g &' .,J
A permit must be obtained before placement of mobile home on parcel. No Permit No.:
inspections will be made until a valid building permit has been issued. Permit Fee: $ Thillinar
Applicant hew / ///.. Property Owner jJ6L ikge.4
Address „2..ov Auzey.,G ' Address g.305--,54-•/ OS
aoefi,sb�-y AP,-) /z / r�i`O,L�vyiR , /r!t'
Phone '3C- 303- LWJ1 Phone '22 -6A-0 I
Contact Person for Building&Code Compliance: t206// Jf. ie_//tt- Day Phone:
s&5 303 Sof
Name of Installer or '' // Proposed Date of Placement
Mobile Home Dealer 4 'L ,tf1C[4 Name of Mobile Home Park
Address
ss---5,1, /1} S CAn^ia Property Location Gigs"IAE�^�
Phone — ZZ(s 6/SO Tax Map ID 309, 9 —2-- / ascii"
Complete information below found on a "Plate"or"Sticker"which is affixed to the mobile home:
• Insignia serial number:
• Name of Manufacturer: (1/47,01.1
• Place Approval Number.
• Model or Component Designation: (New home only)
• Date of Manufacture:
Mobile Home Information Zoning Information
Approximate Value of Home $ I YOM) Zoning
New Home or Replacement Net.° Size of property S? ft.x%1O ft.
Size of Mobile Home /V ft. by foo ft. Existing Building(s) A/p/jL
Singlewide or Doublewide S re)5 iz Accessory Bldgs. ONC
Number of Rooms(exclude bath) Storage Building(s) NO/ye.
Number of Bedrooms 3 Detached Garage _1 car _2 car _3 car
Number of Bathrooms a Attached Garage _1 car _ 2 car _3 car
Gas Fireplace Setbacks Front Yard: AO feet
' Woodstove Rear Yard: /.S- feet
Wood Fireplace Side Yard: /0 feet
Foundation Support Size Depth Water Supply Well
{� Piers QU s4vk1 Municipal
�
' Runners_ Septic Permit Required?
P Slab
Town of Queensbury Building&Codes Mobile Home Permit 518-761-8256
I
A
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:
Signature:
Owner,Owner's Agent,Contractor
Date:
Special Conditions of Permit:
By: Code Enforcement Officer
Town of Queensbury Building&Codes Mobile Home Permit 518-761-8256
M'
&LC
Queensbury Building & Code Enforcement — Manufactured / Modular Final Inspection
Office No.(518)761-8256 Arrive: am/pm Depart74am/pm
Date Inspection (
request received 'I (ep 12A- Inspector's Initials:
NAME _ 1��1� Y 1 G& PERMIT it 4-4 Ciel.I
LOCATION: 45 \rGiSclni DATE: 8I T17.04S
`JJ
Manufactured Home
i./
Modular Home
Footings_ Foundation_ Backfill Framing_
Comments:
Yes No WA
Foundation support, pier spacing, /
Per manufacturer Ilk?: bob565-5735 - 5z 1 I
Anchoring per manufacturer 2'from endsVac`
Water line shut off V nn,'
Sewer line support 4 feet ✓ CILA( bq VJ U r�n
V 0v,
Heating Crossover(doublewide}off grd. ✓ �]
Dryer vented outside Y
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 Fire proofing
Fire Door I Door losers
Plumbing Fixture/3'Vent through roof[Modular]
4.7
Foundation insulation[rf applicable] 1,
Smoke/Carbon Monoxide Detectors/Interconnected
Final Electrical
Variance required ✓
Data Plate okay l�
Manufactured HUD seal okay > '4At rTC`/ 23 C
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 V40
911 Street number
Okay to issue CIC
or C/O[Temp./�P�jenn_] p
Model# 1r01N �VR Serial# 1—QV/I 1,2-035-12A1,2-035-12Ai
Manufacturer k 04
Date of Manufacturer k..0 VOA \c
L-\Pam Whiting\2010\Bulding Codes Fonns\Manufacfured_Modular Final inspection 0304 10.doc
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s•eLye
e• MIDDLE DEPARTMENT INSPECTION AGENCY, INC. 0
Cie. that the electrical wiring to the electrical equipment listed below has been examined and is approved as Yrs
(�
Linbeing in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date 4F>>
;a noted below and is issued subject to the following conditions.
fG• `J,
Owner: Homestead Village Date: 01/05/2015 �rj
cel Location: fir`',
(u Occupant: Same Windsong Dr Lot 45 FSS
�� "Queensbury,Warren Co. NY teal
' Occupancy-
(1,-,oFamily g �
(4,• Single Dwg.
r% Applicant: r
y� Robert Lawrence _ `=�-k __ fl
184 Adirondack St a :4-it, t P 4_ j ,,A
�J Queensbury, NY 12804-;„ dfdTeel
.k. Lfl re.#..
•
epi Joseph A.Holmes ` - "1 .\ :;•
R Cl
Ve No. • 318014164629EL _ _ - {. - — - ------ - — ='
t‘N Equipment: 1
( ;,-..p
, - ..ca :..,« -.9_ b.€P a-®.,te,.,�.i,3vir 7.
A
1 - 100 Amp Feeder To Home
fif, 6
Cp " - `z cel,. ;�1 µ ` _ ..7 ._
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� S4�, Yl `~1' 'ki d ws
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..5,. 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 J�
fi•,,� 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 1f);
(`,� inspection. No warranty is expressed or implied as to the mechanical safety,eth- of the property indicated above,this certificate shall be immediately null and void. ((j
b�� 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, .u'
„\ 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
Itk 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 ;;J)2
((tS ed to,the introduction of additional electrical equipment andtor the replacement of Department Inspection Agency, Inc. to initiate the inspection and revalidation 0?)y any of the components installed as of the above noted date,this certificate shall be process. A fee will be charged for this service.
(61i�.2u•ro•-e5W•e;,.g+, 5`X4. ,,,, ',•.�iF T F i�. �n yATu:.. ..�v '. .r�{r'v,, , .,(ice( ,, , a 5i:�i?:: 4C-x5 .5 5 5 -,:i-.5 5 t, 5{--,•,: �{—n5;•�1.
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Foundation Inspection Report
Office No. (518) 761-8256 Date Inspection rein- eiv:.:
Queensbury Building& Code Enforcement Arrive: % t r Depart: 1‘.:Iglaw
742 Bay Rd., Queensbury, NY 12804 Inspector's InitiaCIT#:
s.
NAME: '4/ t /"4- 99 /4
LOCATION: _. ... ...c INSPECT ON: l fJ g—/44
TYPE OF STRUCTURE: it c, --I
Comments
Y N N/A
Footings
Piers 2-14 95 Y— y$" Ila TpTK
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site.
Foundation/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofing
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building &Codes Forms\Building&Codes\Inspection Forms Foundation Inspection Report.doc
Last printed 12/18/2013 2:44:00 PM
t ( VVE MID)/. N OF QUEENSBURY•
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as
r indicating the plans and soifications are in
8 /74y€2 , i � `C4-HfullNe w York
i tate. with tl a is Codes of
G</ /-fJ�—f New York State.
r� • TOWN OF QUE. j PY'
v Otsttr/mayLiin $471 a'
.zJb BUILDING & F'1.OPT.
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Location: 1Dr
Homestead MobiI6 Home Park