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2005-614 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFI CATE OF OCCUPANCY Permit Number: P20050614 Date Issued: Tuesday, August 23, 2005 This is to certify that work requested to be done as shown by Permit Number P20050614 has been completed. Tax Map Number: 523400-309-009-0002-001-000-0000 Location: 99 ALPINE AVENUE Owner: HOMESTEAD VILLAGE L P Applicant: MELINDA WHIPPLE 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 Enfo cemen 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: P20050614 Application Number: A20050614 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: MELINDA WHIPPLE 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 $6,500.00 Total Value $6,500.00 CALEDONIA, NY 14423 Contractor or Builder's Name / Address Electrical Inspection Agency Plans&Specifications 2005-614 MELINDA WHIPPLE 99 ALPINE AVENUE 14' X 70' 1986 MOBILE HOME $33.80 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, August 15, 2006 (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 Town uee bury; �VIo y u ust 15, 2005 SIGNED BY ,YJ for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit-- Mobile Home Town of Queensbury, 742 Bay Road, Queensbury, NY 12804 (518) 761-8256 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 In Dice Use Name: Pr'GlL File Permit No. Address: Fee Paid � ` � ;•; Reviewed By: Phone No. l W - a q C7 cl Property Owner Informatiop-, Parcel Information Prcoosed Date of Placement: ✓ r�'�� f�, � ���n Name: Property Location: 4�""" Are. Addres��yU 1-Lt �.� e - 4 Road,Street Avemve /L Name of Mobile Home Park:`��' �:c�. V Iac,e ?,�#42� (ifaPPticabie) - Phone No. ! 4 Tax Map Number: ! Mobile Lorne In formation __ _. Zoning I formation Approximate Value of Home: - Zoning Classification: New Ho me: Yes Nod Size of Property: ft.by $. Replacement Home: Yes No Existing buildings: Size of Mobile Home: 14 ft. by -70 ft Setbacks: front yard &; rear yard ft. Singlewide: X Doublewide: Side yards ft.and ft. Number of Rooms: (exclude baths) '-/^ Number of Bedrooms: 02 Accessory Building(s): circle Number of Bathrooms: I _ Detached garage: 1 car, 2 car, car circle: Gas ireplace/Woodstove/Wood Fireplace Attached garage: I car; 2 car, car vmcce- Storage building: Foundation Support: r b1oG ks -y e dow r1 Other. TYPE SIZE&DEPTH Water Supply. well or Piers s Runners x Slab x Is Septic Permit Required? Yes or No Further information requested on the reverse side of this sheet W c6\v` -,� \0-D � e Name of Installer or Mobile Home Dealer. Address: f U f1.�_ \J-Q- 6,-)ru Phone No. Complete information below found on a"plate"or"sticker"which is affixed to the mobile home. l. Insignia serial number O -1 _ 2. Name of manufacturer. 3. Plan Approval Number: 4. Model or Component Designation: (New Home ONL19 5. Date of Manufa ) (� AFFIDAVIT Town of Queenstnuy -_ —state ofNeww York County of Warren 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 complied with,whether specified or not, and that such work is authorized by the owner. signature• er,owner's agent,archit&-4 contractor Special Conditions of Permit By Form: 11119t1999sh Code Enforcement Officer FINAL INSPECTION REPORT MOBILE / MODULAR Town of Queensbury Budding &Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE- DEPART: RbDINSP:(4 DATE INSPECTION REQUEST RECEIVED: NAME: ' G11- 7 LA01CATIQN.,.-- DATE: PERMIT# MOBILE HOME MODULAR HOME FOOTINGS— FOUNDATION — RACKFILL 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 ....... S. heating crossover(ilblewide) off grd- 6. dryer vented outside ..z................... 7. skirting ventilated .................... 8. hot water relief valve piping outside 9. deck, porches, steps, railing ........ io. furnace/hot water operating ........ 11. garage fire proofing .................. 12. door closers ........................... 13. plumbing fixture ...................... 14. foundation insulation (if appl.)...... IS- smoke detectors ...... ................ 16. final electrical 17. variance required ..................... 18. data plate okay ....................... 19. mobile HUD seal okay .............. Model # Serial # Manufacturer Date Of Manufacturer 74 OKAY TO ISSUE CIO YES V NO comments- tKt5 FINAL INSPECTION REPORT M0931LE / MOOULAR Town of Quemsbury BtAkfing &Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: DEPART:Q,fZ-�INSPI'l DATE INSPECTION REQUEST RECEIVED: NAME: LOCATION- DATE: PERMIT MOBILE HOME A/— MODULAR HOME FOOTINGS FOUNDATION — BACKFUL FRAMING N/A YES NO i. foundation SUIPp0d, Pier spacing per manuf ........................ 2. anchoring per manuf ............... 3. water line shut off ................... 4. sewer line support a 4 feet ....... 5. heating crossover(dbleviide) off grd. 6. dryer vented outside x................... _ 7. skirting ventilated .................... — 8. hot water relief valve piping outside 9. deck,porches, steps. railing ........ 10. ftunaceAxt 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# Serial # 0- Manufacturer Date of Manufacturer OKAY TO ISSUE CIO YES NO Comments: