2005-755 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: P20050755 Date Issued: Tuesday, October 25, 2005
This is to certify that work requested to be done as shown by Permit Number P20050755
has been completed.
Tax Map Number: 523400-309-009-0002-001-000-0000
Location: 169 ELMHURST DRIVE
Owner: HOMESTEAD VILLAGE L P
Applicant: PHILIP & MICHELLE WILSON
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 JW 00t
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: P20050755 Application Number: A20050755
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: pH1T.1p&M1('HF.T,T,E WH,SON
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 $1,500.00
4294 ROUTE 5 Total Value $1,500.00
CALEDONIA, NY 14423
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-755 169 Elmhurst Homestead Mobile Home Park
14' X 52' (1978 MOBILE HOME)
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, October 04, 2006
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the T wn of een ry , ctober 04, 2005
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit— Mobile Home -
Town of Queensbwy, 742 Bay Road, Queensbury, NY 12804 (518) 761-8256 v (�
A building permit must be obtained before placement of mobile home on parcel. No inspections will be made
until a valid building permit has been issued.
Applicant Inform ion
� >D Office Use
Name: i Filet No.
Address: o Fee Paid 0
Reviewed
------ By: ��3
_
-
LL
Phone No. �r'�; `01 l (40
Property Owner Information Parcel Information t
L
Proposed Date of Placement: t� i
Name: ' I la�t 1 lQ q
Property Location: -G
Address: tl�P r YlQ QO' Road,suet, ,
Name of Mobile Home Park: �IC�MSL�IsI 1c�Q
rif applicaNe)
_ c ;
Phone No.
Tax Map Number: N'
_ Mobile.Home Information Zoning Information: .
-. _
Approximate Value of Homer$
-- Zoning Classification:
New Home: Yes No
Size of Property ft.by I
Replacement Home: No
offi
Existing buildings:
Size of Mobile Home: ft. by
Setbacks: front yard &; rear yard ft.
SingIewide: _ Doublewide: Side yards &and ft.
Number of Rooms: (exclude baths) �t
Number of Bedrooms: Accessory Building(s): circle
Number of Bathrooms: /
Detached garage: 1 car, 2 car, car
circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1 car; 2 car, car
Storage building: Yes No
Foundation Support: Other.
TYPE SIZE&DEPTH Water Supply. well or municipal
Piers s
Runners x Is Septic Permit Required? Yes or No
Slab x
Fitrther information requested on the reverse side of this sheet
Name of Installer or Mobile Home Dealer.
Address:
Phone No.
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
I. Insignia serial number -:5 -8-70-35-
2. Name of manufacturer:� ���'�n j ryw-S
3. Plan Approval Number: b.P.A .P,M 9,
4. Model or Component Designation:
(New Home ONZ19
5_ Date of ManufaefWt.' . 0-` 117
_ AFFIDAVIT -
'Town of `
- e ofN Y6rk j
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 1
the described premises and that all provisions of the BUILDING CODE,the
1 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.
owner,own 's agent,architect,conrtracWr
Special Conditions of Permit
Form: 11r1911999sh Code Enforcement Officer
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FINAL INSPECTION REPORT
MO®ILE / MODULAR
Town of Queensbury j
Building &Cade Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-82.56 t
ARRIVE: DEPART: t P:
DATE INSPECTION REQUEST RECEIVED:
--------------------
NAME: ,i I
LOCATION: R ,
DATE: PERMIT~
ll[OBILE HOME��Mowa
HOUR
FOOTINGS v FOUNDATION — BACKFI L_ FRAMING'
NIA YES INO
I. foundation support, pier spacing °
per manuf. ........................
2. anchoring per ma puf. ...............
3. water line shut off ...................
4. sewer line support 0 4 feet .......
S. heating crossover(dblewide) off grd.
6. dryer vented outside ..:...................
7. skirting ventilated ....................
8. hot water relief valve piping outside — —
9. deck, poaches, 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# Se —
Manufacturer C�t, tL*J Ker% >
13ate of Manufacturer
OKAY TO ISSUE CIO NO
Comments:
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ja
ARRIVE:°-')DEPART: NS
DATE INSPECTION REQUEST RECEIV D:
NAME:
LOCATION:
DATE: 9 '- ��' PERMIT# 2u>5 7
MOBILE HOME MODULAR HOME
FOOTINGS _ FOUNDATION _ BACKFILL— 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 ®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. f imace/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 # Serial#
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments:
e
/r NAL INI#PEC+ION REPORT
MOBILE / MODULAR
Town of Queensbury
Building &Code Enforcement y
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART: INS
DATE INSPECTION REQUEST RECEIVE
NAME: U i "� �' S o
LOCATION:
DATE: �� l) PE T#
MOBILE HO OIDULAft H
FOOTINGS : FOUNDATION ^ BACKFILL_ FRAMING
NIA YES NO
1. foundation support, pier spacing
per manuf. ........................ — — —
2. anchoring per manuf. ...............
3. water line shut off ................... .
4. sewer line support (&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. funnace/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 # Serial#
Manufacturer C1Aixt 1�
Date of Manufacturer ^Z �
OKAY TOE YES NO
Comments:
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TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804-5902 518-761-8201
September 23, 2005
Manager- Homestead Mobile Home Park
200 Luzerne Road
Queensbury, NY 12804
RE: Philip and Michelle Wilson
Year 1978 Mobile Home
Serial Number: F-58-8-7035-2787
Dear Manager:
Inspection of the above-mentioned mobile home meets New York State
standards for placement of such home in the Warren County, NY region
and to be placed within your park at 200 Luzerne Road. However, due to
the lot size and configuration of lot 23 Windsong Drive, the mobile home
(14 ft. by Set'j yvill not meet zoning setback requirements. The mobile
home rKu. e moved to another lot within your park. The mobile home
will meet such setbacks on lot 169 A t* Street.
E--t-Mt-�S
The current permit applied for on lot 23 Windsong Drive (BP 2005-755) may
be applied to lot 169 Adirondack Street. The only additional requirement
. for the permit is an accurate plot plan depicting the exact placement of
the home on the lot. The applicant, Philip and Michelle Wilson understand
this and will comply to the Town of Queensbury's requirements for a
building permit.
Thank you.
Sing ely,
John O'Brien
Code Enforcement Officer
JOB/sh
"HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE"
SETTLED 1763