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2007-408 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20070408 Date Issued: Thursday, August 09, 2007 This is to certify that work requested to be done as shown by Permit Number P20070408 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 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 (2t 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20070408 Application Number. A20070408 Tax Map No: 523400-3 09-009-0002-001-000-0000 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 $15,000.00 4294 ROUTE 5 CALEDONIA, NY 14423 Total value $15,000.00 Contractor or Builders Name/Address Electrical Inspection Agency Plans &Specifications 2007-408 96 ALPINE AVE - Anna Tracy&Kyle Anderson $48.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Sunday,July 13, 2008 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Towirf Qt`tavnsbu Fr ay,Ju ..13,2007 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement if if T<wV'_2 w tT/Rf lfl s/II//II/IIRI fR/if/I liwf d/wO III/w"�/f wwns<I fi f/ f................... 7 l , OFFICE USE ONLY L•-l �� l U �j TAX MA NO. -PERMIT NQ d b DATE ISSUED: PERMIT FEE APPROVALS: ZONING TOWN CLERK 0 , , .i.f. .................f...._'_.................................fff/� MOBILE HOME —APPLICATION FOR PERMIT A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a valid building permit has been issued. Applicant Information Property Owner Information Name:flnrla I ro Cep xN 1e And e rSon Name: HomeS "�c U►1 l a4'e Address: J -I W4Sk i ngL6 n /A Address: L-0 Z-2r h e- �J u1Arc0 Nu IQ Fak Do t er)s L./,, a�6 Phone No. 51dqgD -2 y Phone No. Morri's Cc",.3 , f>a✓K Mu­�rer: Lctrry PCISCO Parcel Information 17g7 -ems Proposed Date of Placement: Propertytocation: t tt 11 Road,Street,Avenue Name of Mobile Home Park: 6LM�.S-�'(_aj lJ i IrL C(if appi abie) Tax Map Number. __......._._.._..... - -- -._..._.._ _ Mobile Home Information = Zoning Information Approximate Value of Home:$ Zoning Classification: New Home: Yes : Size of Property: ft.by Replacement Home: Yes No : Existing buildings: Size of Mobile Home: I ft. by 5� ft. i Setbacks: front yard ft. rear yard ft. side yards ft.and ft. Singlewide: Doublewide: Number of Rooms:(exclude baths) _ ' Accessory Building(s): circle 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 Foundation Support: Storage building: Yes No Type Size & Depth Other: �e Water Supply: well or municipal Runners Slab = is Septic Permit Required? Yes or No ... -- _. .........____ .... ___..._..__ ____._.___.._ __._.; _...._.___.__......_....__. Continued on bade Town of Queenslniry- Community Development Office• 742 Bay Road, Queensvury, iv Y Lzov* Name of Installer or Mobile Home Dealer (, D M b TfG- Addressl A Phone: 2 7 S Complete information below found on a"Plate"or'Sticker*which is affixed to the mobile home: Insignia serial number. 3 _ �� C �1� ✓ Name of manufacturer. R o i�f 1 A e- 1"/�l D�r I � T'1 O fYIP s �"i ai r n u.V e j l V Pf'M6n-f- Plan Approval Number: ✓ Model or Component Designation: 6 j/�/�Q (New home only) � Date of Manufacture: / r .r�«��«««•ar«._««._«:s��«:.:r.:-._^«««•:rr._ F�««:r•�«««««•:rcr-:.r..•�.-««._._«.-.r--«._.r.,� r AFFIDAVIT` J J J Zz Town of Queensbury State of New York r County of Warren x J J 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 z that all provisions of the BUILDING CODE, the ZONING ORDINANCE, and all other laws pertaining to the proposed work shall be complied with, whether specified or not, and that such work is authorized by the owner. y C Y Signature: C.&m A,�x 1/( j s Owner,Owner's Agent,Architect,Contractor a 4 .•is�:�.-1za:_______�._i.l._.,.u._a._J._..w._i1._1.'1.'Kw'�.'�._we1._.Kai+:+:r.y_1:1._r._J:a.+:aTr:l1.-y-I:�/:JJ4y-�.a.-�.-a:J:a.-J:.++:a:h SPECIAL CONDITIONS OF PERMIT By: Code Enforcement Officer Town of Queensbunj• Community Development Office• 742 Bay Road, Queensbury, NY 12804 C) /C5� A ;7 TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 518-761-8201 AFFIDAVIT TOWN OF QUEENSBURY STATE OF NEW YORK COUNTY OF WARREN I swear that the following used mobile home that will be transported into the Town of Queensbury for placement will have the following. A building permit approved and issued, meet all zoning requirements, the mobile home's HUD sticker affixed to mobile home and meet HUD requirements for the Middle Zone. As the person responsible for the transport and placement of this mobile home, I accept total responsibility for removal of the mobile home from The Town of Queensbury, if it does not meet the requirements for placement. Signature: Date: (9 D 7 Mobile Home Owner, Ow er's Agent, Mobile Home Contractor Signature: Date: Town of Queensbury Code Enforcement Officer "HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE" SETTLED 1763 A. FINAL INSPECTION REpOpM MOBILE / MOCULAF!�, Town of Queensbury Building &Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 MMW�!"—Z�- EPART-,�'L DATE INSPECTION REQUEST RECEIV NAME: LOCATION: I(o A� DATE: V D Pmmrr#40 MOBILE HOME MODULAR MOW FOOT&RM— FOUNDATION — BACKFRL— FRAMM NIA YES No I. foundation support, pier spacing per n2anuf. ........................ 2. anchoring per nianuf. ............... 3. water line shut off ................... 4. sewer line support 0 4 feet ....... 5. beating crossover(dblewide) off grd- 6. dryer vented outside x................... 7. skirting Ventdated .................... laihot water relief valve piping outside deck, porches, steps, railing ........ 0. water operating ........ I I- garage fire proofing .................. 12. door closers ........................... 5) phunbing fixture ...................... 14. foundation insulation (if appl.)...... 15. smoke detectors. ��gg�� i� � _ 16. final electrical 17. variance required ..................... 18. data plate okay ....................... 19. mobile HUD seal okay .............. serial#01(0-01111P Manufacturer Date of Manufacturer OKAY TO ISSUE CIO YZ YES NO Comments. R7 (101-00 2-uz ---In �FlrtAL INSPECTION AEpCMT MOBILE / MOOULAR Town of Queenstwry Building &Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE:` DEPART INSP: DATE INSPECTION REQUEST RECEIVED: NAME: \ r ATION: �V`�`W i� '�E: Z' Z > PERMIT# 0 `- MOBILE HOME MODULAR HOME FOOTINGS_ FOUNDATION , BACKFII.L ^ FRAMING_ N/A . YES NO I. foundation support, pier spacing per manuf. ........................ 2. anchoring per manuf. ...... .. ... 3. water line shut off ................... — 4. sewer line support 0 4 feet ....... � — 5. heating crossover(dblewide) off grd. _ 6. dryer vented outside ..:................... _ 7. skirting ventilated .................... _ 8_ hot water relief valve piping outside 9. deck, porches, steps, railing ........ _ 10. furnace/hot water operating ........ 11. garage fine 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 > SerialJJC Manufacturer Uc5pQe�1 Date of Manufacturer OKAY TO ISSUE C/O YES NO Comments:VqV v'C � �, C,,rrjz.ti.5 Abe � � ` 10--12. -7i,�sWay 6�"/;34�/20;7 FINAL INSPECTION RE MOBILE / MOOULA Town of C?ueer�bury �`��P &Code Entoa 742 Bay Road 747 Queensbury, NY 1 a7� Z rer (518) 761-8256 ARRIVE.ADEPART: I DATE INSPECTION REQUEST RECEIVED: '"z- 3 NAME: I 0. 3/jz LOCATION: kw& S DATE: O PERMIT MOBILE HOME MODULAR HOME FOOTINGS— FOUNDATION _ BACKRU 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 0 4 feet ....... 5. heating crossover(dblewide) off grd. — — — 6. dryer vented outside ...:................... 7. skirting ventilated .................... — 8. hot water relief valve piping outside — — — 9. deck, porches, steps, railing ........ — — — 10. furnace/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 # `J �(` Manufacturer (� Date of Manufacturer 2/ t/ OKAY TO MSW V YES NO Cam: 1 �.' � r �' MIDDLE DEPARTMENT INSPECTION AGENCY, INC. '6�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. 07 _/�� Owner:. Mike Garvey Date: 08/07/2007 'Y Occupant: Unknown Location: 96 Alpine Street Occupancy: Trailer Queensbury, Warren Co. NY Applicant: Village Mobile Home Brokerage 130 Milton Avenue 0 � Ballston Spa, NY 120 ntfrf Raymond A. No Equipment: ffi 100 Amp Service Equipm t#2; nl VISC y 4 ft ,.r q i a � . "z 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,effi- of the property indicated above,this certificate shall be immediately null and void, 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, 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 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 ed to,the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc. to initiate the inspection and revalidation any of the components installed as of the above noted date,this certificate shall be process. A fee will be charged for this service. 7_Z/a�' NOTICE ANCHORING Of MOBILE HOME FRAME IS REQUIRED PER MANUFACTURERS SPECIFICATIONS f i -3 > PIC 1?5 a p L. v WDc19 2Ln' D-� �34v�X5 TOWN OF QUEENSSURY SUIT lieu UEPAR MENT Based on our limited xam;nation compliance with our co meets shal not be construed as ' ' sting th plans and specificatio re to fut compliance with the Build g Codes New York State. 0 . t ` j 1� I �f �M p o e t � � 3 Z � P ct , 7 - sty O/1 < r tt Cam, ^ z-Y� .S,b sT s'8 Y r �h r9 1 A Z `t (,, (� `y "•= ;c� Via` G� �d ica i GyIlk A Lnf . G 4 ! , , " .1 4,-).l 01 v.iJn IT, ! � , Wo Inv- -777-7 •.Y�� 1VW�/CNr �1 �� 16t,i 1 q