RC-0003-2017 1
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-0003-2017 Date Issued: Tuesday, April 4, 2017
This is to certify that work requested to be done as shown by Permit Number RC-0003-2017
has been completed.
Tax Map Number: 309.9-2-1
Location: 200 Luzerne RD
Owner: Homestead Village
Applicant: Homestead Village
This structure may be occupied as a: 14 ft.by 70 ft.Mobile Home
Lot 63 Alpine Avenue By Order of Town Board
Homestead Mobile Home Park 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 other issues and conditions as a result of approvals by the
Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-0003-2017
Tax Map No: 309.9-2-1
Permission is hereby granted to: Homestead Village
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
Tyne of Construction
Owner Name: Homestead Village Mobile Home $40,000.00
Owner Address: 200 Luzerne RD Total Value $40,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Homestead Village
200 Luzerne RD
Queensbury,NY 12804
Plans&Specifications
14 ft.by 70 ft.Mobile Home
Lot 63 Alpine Avenue
Homestead Mobile Home Park
$117.60 PERMIT FEE PAID-TIES PERMIT EXPIRES: Thursday,January 18,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queens before the irat n dat .)
Dated at the Town f Quee b W ,January 18,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
MOBILE HOME APPLICATION
Received
,DATE: \�(Q 10 Tax.Map I D
? Permit No. = (j
Tax MAP ID � ~' Permit Fee _ 117-
PROPERTY
[ 7-PROPERTY LOCATION: '�" �'{r rk- VIC 1 376
NAME OF MOBILE HOME PARK: - 4 ) V1 a (� ` EPROPOSED DATE OF PLACEMENT: 1 `�
APPLICANT L`i9 r LCTO QUEENSB3
n, l BUILDING&CO �(�
ADDRESS i"7, r[n 'G ��� FNA-
PHONE I �"1(� PHONE b U /—
NAME OF INSTALLER OR MOBILE HOME DEALER
ADDRESS: P (; kA I S C)
J),Jcn , ""i Y 114g 11-1�C
PHONE 19 t� . )" L15(..
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE. ,erg r, 1ti.� t° PHONE:
COMPLETE INFORMATION BELOW FOUND ON A"PLATE"OR"STICKER"WHICH IS AFFIXED TO THE MOBILE HOME
Insignia serial number
Name of Manufacturer 5n
Place Approval Number
Model or Component Designation (New home only)
Date of Manufacture: I,U_n'
MOBILE HOME INFORMATION ZONING INFORMATION
Approximate Value of Home $ h� ,CR') Zoning
New Home or Replacement jvo- / V- oma Size of property _ft.by %2U ft
Size of Mobile Home 11-1 ft.by -70 ft. Existing buildings
Singlewide or Doublewide S:, X� Accessory buildings tip
Number of rooms(exclude bath) 5 Storage buildings Np
Number of Bedrooms �3 Detached Garage ___4- 1?-=3
Number of Bathrooms Z Attached Garage -----T— 3
Gas Fireplace;Woodstove or Wood Fireplace Setbacks Front yard: ft.
Rear yard: ft.
Side yard: ft.
Foundation Support Size Dept h Water Supply Well: —----
Piers 2i y Municipal:
Runners
Slab Septic Permit Required? . Yes _No
Town of Queensbury Building&Codes1
Mobile Home Application July 2014
NOTICE 309.9-2-1 RC 3-2017
ANCHORING OF MOBILE HOME TOWN OF QUEENSBURY Homestead MH Park
BUILDING DEPARTMENT
FRAME IS REQUIRED PER Based on our limited examination,complianpe 200 Luzerne Road
MANUFACTURERS SPECIFICATIONS with our comments shall Mot be construed as Lot 63 Alpine Avenue
indicating the plans and specs tions are m Mobile Home
full compliance with the Building Codes Ion
New York State.
MODEL CASH HOUSE#1
3 BEDROOM,2 BATH TOWN OF QUEPMSBk
NOMINAL SIZE:14'x 74'
ACTUAL SIZE: 13'-4"x 70'-0" FILE COPY BUILDING &
TOTAL AREA:933 SQ.FT.
Reviewed
Date:
V
rMASTER
- - — TUR
BEDROOM #ZDINING BEDROOM #3
8'-8"x 5'-1 9'-0„x 8'-10„ 8'-0"x 12,x„
— —r— LIVINGoRr 1 1 wnsr uR 13'-6"x 12'-4"
BEDROOM rl` E3 1 __._3'0"x 12'-4° KITCHEN 4r-
i
I - -
-, O.W.
REFG
360 3561V
_ APPROVER'S SEAL - _—!_-MODIFICATIONS _ MODEL-.J-952-AGL-CASHHOUS " T
TITAN
14'X 74'2 BED,2 BATH _
T — _—�— TITLE. LITERATURE PLAN _ L-1 O
■ HOMES __ --__ ___-_ ___ _ _ _
PROi�R1ETARY AND CONFIDENTIAL DRAWN BY D.BASLER DATE'10-04-16
)PRW ARY A C ANI Sf-�Gf1:ATIONS ARE ORl(il!!AL
_ �PRIF7.iRY ANO C(Nlfli NT1ACUATERIP1,54r
P.O.BOX 177,RT.12&20 SANGERFIELD,NY 13455 cavr lav1.,;81BaUTY Pv]/AA7 NON SCALE 118"=1'-D"
NOTES__
.MAW BEAM PIER �SIDEWAIL Wk" 1.1 Crwit oll The Sail C4wfty Betore The tWmeis Sewp
�./ Is The Dealers Resrmbilay.
2.1 Fur twtkg Saes See Champon InshelaLGn Manual.
®MARRIAGE LINE OPRIING PIER ®MARRIAGE LRS PIER 3.1 For Dalerect Per Spareg See Charnpon Mstalam Llaauai.
"TTTis pief P18MMOnt drawing is not a
foundation design see current
CHAMPION Installation Manual and
its addendurn(s)for foundation design"
70'
2' 10' 18' 26' 34' 42 50' W 64' 68' 2'
1
-22-
CN
v� N�
M 1 1 1 1 I 1 1 1 1 1
CD I I ( ( I I
1 '�a�wsrs: rwas-+forme .w.wr�era�arwwerwr. rs'rw� MAN :.r-weerreee. 1
t0 1 1 1 1 1 1 1 t l 1
b2''
4 '"$"10' - W 26 '` � 42 -`� 50, 58-!-----
APPROVER'S SEAL MODIFICATIONS MODEL: 1-952-AGL-CASH HODS ITT
T TITAN» � — ~y — 14'X 74'2 BED,2 BATH
- TITLE. PIER PRINT PR-101
®
HOMES _
PROPRIETARY AND CONFIDENTIAL DRAWN BY:D.BASLER GATE.10.04-16
7FrESE ARY AND CANO SENIIA CA TE ARE ORIGINAL
PRDPRI£T�nV AND CCPIPo'JENTIAC MATERIALS CN'CHMAPICN -".�.--__...�_�..—._.__....,
P.O.EOJ(177.R7.12 8 20 SANGERFIELO;NY 13455 COPYRIGHT cae76-2012 BY CHAMPION SCALE US"=1'91
4"twa
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44
S�,
a
70 (Jo
O cA.
Applicant �J� �l �_ c `
Location: o z
Homestead Mobile Home Park
v cMul
n C:
Ap 13. 2017k,11 : 03AM MDIA- No. /d9J r. V
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
r, 7y eAi that the electrical wiring to the electrical equipment listed below has been examined and is approved as
being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date
noted below and is issued subject to the following conditions.
Owners Homestead Village MHP
g Date' 03/30/2017 I
Occupant: Same Location-
83 Alpine Drive
Occupancy: Queensbury, Warren Co. NY
Mobile Home I
Applicant: �
Homestead village Mobile Homes
PO Box 159
Avon, NY 14414
L J
Joseph A.Holmes
No. - - - - - - 318014207$8BEL - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Equipment:
1 - 100 Amp Feeder To Home
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
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
inspection. No warranty IS Expressed Or Implied as to the mechanical Safety,effl- of the property indicated above,this certificate shall be immediately null and void.
1 ciency or fitness of the equipment for any particular purpose, This certificate shell In the event that this certificate becomes invalid based upon the above conditions.
1:6 valid for a period of one year from the above noted date. Should the electrical this Certificate may be revslldated upon reinspection by Middle Department
system to which this certificate applies be altered In any way,including but not llmib Inspection Agency, Inc. An application for Inspection must be submitted to Middle
ed to,the introduCfion of addl(IOnal slectricfll equipment andlor Iha replacement of Depa.nment Inspection Agency, Inc. to initidte the Inspection dnd revalidation
any of the Components InStalletl as of the above noted dale,this ceniflCe(E shall be process. A fee will be Charged for this Service.
Er, E O V E
D
APR 13 2017 0
TOWN OF QUBBNSBURY
BUILDING&CODES
�tG—Cot�3
-'2-0 1�
INSTALL NO. STATE OF NEW YORK RG
DEPARTMENT OF STATE
Iwo ONE COMMERCE PLAZA
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:
B. HUD label number: T A 1 -7 L4 1: Serial number:cj` - &,c i `f4 -A(,C-,3L4 L
C. Retailer's name: C k f1
t M t^� _,L Nt
D. Retailer's address: = '�� 1�i` - ( P" ,'
E. Retailer's certification#: I iCt-7 t l q 44 C Telephone#:
R Installer's name: r .f._ Ff , - C l
Cy. Installer's address: ` ! Zc nu ct - Cr,i„C._r N l d.4_ ,( i"ta, ,J'r{� `�` .y `'1 1 '4
H. Installer's certification#: - (` -C'C Telephone#: - -C)( -
I. Date installed: - t*-4 Municipality issuing building permit:
ity.TowVil
n, lage}
J. Customer name and physical address (911)where home is installed: t i( l I
';tv iz 6L�L � —,Newyork
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,whether contractually or by operation of law.
Printed Name of Person Signing Seal_
{ " ?
Signature of Installer or,'`
Limited Installer: Oa,
J �-
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