2008-620 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CE RT I F I CAT E OF OCCUPANCY
Pernut Number. P20080620 Date Issued: Tuesday, December 09, 2008
This is to certify that work requested to be done as shown by Permit Number P20080620
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 maybe 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 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 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080620 Application Number. A20080620
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is herebygranted 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
4294 ROUTE 5 Mobile Home In Park $5,000.00
CALEDONIA,NY 14423 Total value $5,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2008-620
94 ALPINE DRIVE - 980 sq ft mobile home in park
$58.80 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,December 05, 2009
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the f Quee bu ay,December 05,2008
SIGNED BY -I Ifor the Town of Queensbury.
Director of Building&Code Enforcement
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TAX MAP NO. PERMIT NO. V J DATE ISSUED: S ;
PERMIT FEE�<LSZ APPROVALS: ZONING TOWN CLERK OOZ L I AON
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MOBILE HOME —APPLICATION FOR PERMIT:
A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a
valid building permit has been issued.
Applicant Information Property Owner Information
Name: Ictidd Name:
Address: Address:
Phone No. c �-i �lQt>V7'.�,�`7 Phone No.
9
Parcel Information
Proposed Date of Placement: Property Locatio ,
Roa , ieet,Avenue
Name of Mobile Home Park:LS Al ALS (if apprcable) Tax Map Number:
Mobile Home Information 1 Zoning Information
Approximate Value of Home:$ Zoning Classification:
Size of Property. ft.b ft.
New Home: Yes Noy
Replacement Home: Yes No �$o : Existing buildings:
, � -�f4 1
Size of Mobile Ha e: --'--�—ft. by ft : Setbacks: front yard ft. rear yard ft:
side yards ft.and ft.
1 Singlewide: Doublewid
Number of Rooms:(exclude baths) ? Accessory Building(s): circle N�N6
Number of Bedrooms: ^ `•
Number of Bathrooms, ' Detached garage: 1-car 2-car car
Circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1-car 2-car car
P
Foundation Support: Storage building: Yes No
pe Size & Depth Other:
Piers'. ....._._
Runners € Water Supply. well or {..
municip
Stab
Is Septic Permit Required? Yes or
MCmUnued on back
Toum of Queenstnsnj• Community Development Office• 742 Bay Road, Queensaury, 1v r 1,46u*
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Name of Installer or Mobile Home Dealer: l _ o m bS
Address: Phone:
Complete information below found on a"Plate"or"Sticker"which is affixed to the mobile home:
✓ Insignia serial number. 1 � � L L :� 11 1 C, 2L
✓ Name of manufacturer:
✓ Plan Approval Number:
✓ Model or Component Designation: 4Q 60 C\,
I , / I 'r, (New home only)
✓ Date of Manufacture:
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AFFIDAVIT
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Town of Queensbury State of New York
County of Warren x _
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I swear that to the best of my knowledge and belief the y
statements contained in this application, together with the plans
and specifications submitted, are a true and complete statement
5 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 y
shall be complied with, whether specified or not, and that such y
work is authorized by the owner. y
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Signature: //1'rt'j�
caner, wv is Agent Architect,Contractor
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SPECIAL CONDITIONS OF PERMIT
By:
Code Enforcement Officer
Tou)tt of Queensbury• Community Development Office• 742 Bay Road, Queensbury, NY 12804
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Plot Plan
Lot 94 Home stead village
Luzeme rd.
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bftirxm NOTICE
OF MOBILE DOME
FRAME IS REQUIRED PER
MANUFACTURERS SPECIFICAi IONS
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COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No.........................................Cert. N2 93263 Cut-in Card No....................................
Owner.............. .............. ...............................................................................
Location................. .................. ....... ..................
Installation Consisting of......../.q.Q/4..... ..... ........
....................................................................................................................................................................................
.............................................................................................................................................................I......................
InstalledBy.....Szl&nsrr:.:............................................................Lie.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of making inspections at any time, and if its
rules are violated,the Company shall have the right to rev this certificate.
Date.... -.'L:qk................ INSPECTOR ....................................
Member N.F.P.A.,I.A.E.I.
f "� ;-. fit�'-?'�-��:�-L � ,'✓ii,�
FINAL INSPECTION REPORT
MOBILE / MOOULAR /
Town of Queensbuy
Buildng &Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART: INSI
v�
DATE INSPECTION REQUEST RECEIVED:
NAME: , �l/(/l d 111 /�444 - -30,'-S 6-3
LOCATION: ��
1
DATE: L , PERMIT#
MOBILE HOME MODULAR MOME
FOOTINGS TION sACKFIIL FRAMING
N/A . YES NO
1. foundation support, pier spacing
per manuf. _
2. anchoring per manuf. ............... _ — —
3. water line shut o ................... _ — —
off
4. sewer line support(0 4 feet ....... _S. hearing crossover(dblewide) off grd. — — —
6. dryer vented outside ..:................... _
7. skirting ventilated ....................
8. hot water relief valve piping outside — — —
9. deck, porches, steps. railing ........ — — —
10. f umce/hot water operating ........ _ —
11. garage fire proofing .................. _ —
12. door closers ........................... _ —
13. plumbing fixture ......................
14, foundation insulation (if appl.)...... — — —
o. smoke detectors ....................... — f —
16. final electrical ........................
17. variance required ..................... — _ —
18. data plate okay ....................... — — —
19. mobile HUD seal okay .............. — —
Model fi Serial#
Manufacturer
Date of Manufacturer
OKAY TO ISSUE CIO .YES NO
Comments:
L:
INAL INSPECTION REPORT
MOBILE / MOOULAR
Town of Queensbury
Building &Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 76141256
ARRIVE: DEPART: t NSP:
DATE INSPECTION REQUEST RECEIVED:
NAME:
LOCATION: i LI • V
l - fl
DATE: , � ��y� PERMIT dl 000
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION RACKFI L FRAMING
N/A . YES NO
1. foundation support, pier spacing
per manuf. ........................
2. anchoring per manuf. ............... _
3. water line shut off ...................
4. sewer line support(M 4 feet .......S. heating crossover(dblevAde) off grd. _ —
6. dryer ve_rated outside .x...................
7. skirting ventilated .................... — —
8. hot water relief valve piping outside — —
9. deck, porches, steps, railing ........ _
10. fiunaceAKA water operating ........
11. garage fire proofing ..................
12. door closers ........................... —
13. plumbing fixture
14. foundation insulation (if appl.)......
15. smoke detectors ....................... -
16. final electrical ........................ —
17. variance required ..................... _ —
18. data plate okay ....................... — —
19. mobile HUD seal okay .............. —
Model #VA-V L-L1A6Z.ASerial# j
Manufacturer f4EIeLA—
mm
Date of Manufacturer
OKAY TO ISSUE CIO NO
Comments:
FINAL INSPECTION REPORT 0r-e—
MOBILE / MOOULAR """tttttt
Town Of Queensbury �` Z
Building &Code Enforcement
742 Bay Road
Queensbury, NY 12804 G(n.
(518) 1-8256
ARRIVE: ART: INS = ��
DATE INSPECTION REQUEST RECEIV
NAME: w i t C�lv. �C dT�. 7-.23 3
11 ATTON:
DA PERMIT#
11[OBU HOPA MOWLAR'HOPM
FOOTINGS FOUNDATION BACKFIIL FRAMING
N/A . YES NO
1. foundation support, pier spacing
per manuf. ........................
2. anchoring per manuf. ............... — — —
3. water line shut off ................... — —
4. sewer line support a 4 feet ....... —S. heating crossover(dblewide) off grd — — —
6. dryer ve_nted outside ......................
7. skirting ventilated ....................
8. hot water relief valve piping outside — — —
9. deck, porches, steps, railing ........ — —
10. fumace/hot water operating ........ _
11. garage fire proofing .................. _ —
12. door closers ........................... _
13. plumbing fixture ......................
14. foundation insulation (if appl.)...... — —
15. smoke detectors ....................... _ — —
16. final electrical ........................ _ — —
17. variance required ..................... _ —
18. data plate okay ....................... _ —
19. mobile HUD seal okay ..............
model 9A LL7-2 >gC� -
Serial#
Manufacturer
Date of Manufacturer
OKAY TO 1 -ef9 YES NO
Comments: