2004-026 ry
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:. P20040026- Date Issued: Wednesday, April 06, 2005
This-is.to certify that work requested to be done as shown by Permit Number P20040026
has been completed.
Tax Map Number: 523400-309=009-0002-001-000-0000
Location: 200 LUZERNE Rd
Owner: HOMESTEAD VILLAGE L P
Applicant: CYNDIE RUGGIERO
This structure maybe occupied as a:
By Order of Town Board
Mobile Home In Park TOWN OF QUEENSBURY
^ 4�{
Director of Building&4fode Enforcement
I_
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040026 Application Number: A20040026
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: RI TCTCTTF,Rn•
For property located at: 200 WZERNE Rd
in the Town of Queensbury,to constrict 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. _' i' kl' ;;'Type of Construction Value
Owner Address: HOMESTEAD VILLAGE 'LIP
4294 ROUTE 5 Mobile Home In Park $5,000.00
CALEDONIA;NY 14423 Total Value $5,000.00
Contractor or Builder's Name Address ' 3 {, Electrical Inspection Agency
I
!
Plans&Specifications
2004-026 12 WINDSONG DRIVE
980 SQ FT MOBILE HOME (1983 MOBILE HOME)
$33.80 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, January 28, 2005
f
(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.) 1.
4 1'
Dated at the To7 eensb d VY d Way; 4October. 06, 2004
SIGNED BY 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 Information
Office Use
Name: �V
File Permit No.
RECEIVED:
Address: uj//,C�j Fee Paid 33J2
2004
Reviewed Ey:
.................................................... TOVV!q OF UUt—:F ffS-B—URY
Phone No. BUILDING AND CODE
Property Owner Information Parcel Information
Proposed Date of Placement:
Name: 4 S! G/r/664 3�==-
Property Location:
.............
Address:. Road,slll�venue
Name of Mobile Home Park:
(if applicable)
Phone No.
Tax Map Number aDd/o� --a
Mobile Home Information Zoning Information
Approximate Value of Home: $ /Zoning Classification:
New Home: Yes
11� Size Of Property: _ft.by ft.
Replacement Home: LYes-" No
Existing buildings:
Size of Mobile Home., ft. by-7(2 ft.
Setbacks: front yard fL; rear yard ft.
Singlewide: Doublewide: Side yards ft.and ft.
Number of Rooms: (exclude baths)
Number of Bedrooms: Accessory Building(s): circle
Number of Bathrooms:
Detached garage- I car; 2 car, _car
circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: I car-, 2 car, _car
Storage building: Yes No
Foundation Support: Other:
TYPE SIZE&DEPTH Water Supply. well or municipal
Piers x
Runners x Is Septic Permit Required? Yes or No
Slab x
Further information requested on the reverse side o this sheet E00-
!f
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.
1. Insignia serial number. ('7 f���j?!-g
2. Name of manufacturer J _ 11D /
3. Plan Approval Number:
4. Model or Component Designation:
(New Home ONLY q
5. Date of Manufacture:
AFFIDAVIT
Town of Queensbury State of New 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: —�-
owner,owner's agent,architect,contractor
Special Conditions of Permit
By.
Fonn: 11/19/1999sh Code Enforcement Officer
09/22/2004 20:29 5748253050 HOLLY PARK PAGE 01/01
e'
HOLLY PARK
9123/04
To: Homestead Village
Attn: Bob
From: Ho119 Park Division,Indiana Building Systems,LLC
51700 Lovejoy Drive
Middlebury,IN 46540
Dear Bob,
Although we did not build the unit you have in question,it is our practice that all 2x6
14'homes are builtwith a 30#roof load,middle zone construction. The standard 2x4
homes are built to south zone 20#roof load.
If you have any questions,please feel free to call me @ 1-900-204-6559.
Martha senderaon
Sales Manager
Nil
�a . > ,� iec �j�,/2✓�Qfi dC� r JS //J Sly ftJ Uk
HOLLY PARK DIVISION,TNDIANA BUILDING SYSTEMS,I.I.C.
51700 LOVEJOY DRIVE-MIDDLEBURY,IN 46540-TEL 574-825-3700 -FAX 574-825-3050
WWW HOLLY--PARK.CON
C
L INSPECTION REPORT
WMI BILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART: �� I '
DATE INSPECTION REQUEST REECEIVE �-//3
NAME eRuG�« �►��Jl '.�.,/�
LOCATION:.JJ��
DATE: PERMIT N a(fif'
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION BACIFILL FRAMING
N/A YES NO
1. foundation support, pier spacing /
per manuf. ........................ — ✓ —
2. anchoring per manuf. ............... —
3. waterline 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. 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 # Serial#
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments:
r
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury �y�M
Building & Code Enforcement dd
742 Bay Road
Queensbury, NY 12804,�
(518) 761-8256
ARRIVE: 212,'- DEPART: INSP: �
DATE INSPECTION REQUEST RECEIVED:
NAME:
�LOCATIONPNc,L 4) 4)1 16 SO- A q
DATE: ,3I! °Za� PERMIT#�
M0131LE HOkE MODULAR HOME
FOOTINGS FOUNDATION BACKFILL FRAMING
N/A YES NO
1. foundation support, pier spacing
per manuf. ........................ — — —
2. anchoring per manuf. ...............
— — —Iwater line shut off ................... . _
4. sewer line support Q 4 feet .......
5. 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 # Serial#
Manufacturer
Date of Manufacturer
OKAY TO ISSOE C/O YES NO
Comments:
�lv:-
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
G
�518) 761-8256
ARRIVE:zP3 DEPART: INSP.0k
DATE INSPECTION REQUEST RECEIVED:
NAME: ,yi it {t/fly
LOCATION:
DATE: /2- L c`l PERMIT# — 1CIN
MOBILE HORSE MODULAR HOME
FOOTINGS FOUNDATION BACKFII.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 (D 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. 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 # Serial#
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments:
}
FINAL INSPECTION EIPORT
MOBILE / MOOL ILAR 3 ffJ�
Town of Queensbury
Building & Code Enforcement �� I
742 Bay Road
Queensbury, NY 12804 t,
(518) 761-8256 PIN
ARRIVE: DEPART: I INSP:
°
DATE INSPECTION REQUEST RECEIVED:
�I
NAME:
LOCATION:
DATE:
MOBILE HOME MODULAR HOME
o �- DO�Qp
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 .................... —_
S. hot water relief valve piping outside — — —
9. deck, porches, steps, railing ........ _
10. himace/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: �
6
FINIAL INSPECTION REPORT
MOBILE / MOOULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY .12804 1
(518) 761-8256
ARRIVE: ` i DEPART: INSP:
DATE INSPECTION REQUEST RECEIVED:
NAME: fJ rU
LOCATION:
DATE: (! PERMIT#
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION BACIFILL 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 ...................... I/
7.. skirting ventilated .................... —
8. hot water relief valve piping outside —
9. deck, porches, steps, railing ........ — —
10. fiumace/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: ��� A
FINAL it isPECTI®N RrzPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART:-7 �nr IN
DATE INSPECTION REQUEST RECEIVED-
NAME: ('
LOCATION; La ")Sanc,
DATE: -q PERMIT# _0 a
MOBILE HOMS MODULAR HOME
FOOTINGS FOUNDATION BACI¢TLL 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 .,3c — —
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 ....ti` 3:�.�%P�z —
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:
Y
FINAL INS ECTI®N REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road f
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART: INSP:
DATE INSPECTION REQUEST RECEIVED:
NAME:
LOCATION:
DATE: ` PERMIT# li
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION BAC144ILL FRAMING
N/A YES NO
1. foundation support, pier spacing
per manuf. ................. — —
2. anchoring per manuf. ............... _
3. water line shut off ................... . _ f
4. sewer line support a 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 �g ........ —40. deck,ftirnaceN
t water opera� " ........
11. garage fire proo g ...........:......
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 # l// Serial #
Manufacturer .A �r
Date of Manufacturer J�e /� ' �� 7(/
OKAY TO ISSUE C/O YES NO
Commeg�s/vim V/,, e
4i Gr
FILIAL INSPECTION REPORT
MOBILE / MOOULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE:`J'' - DEPART: INSP:
DATE INSPECTION REQUEST RECEIVED:
NAME: cf C'J E
LOCATION: L.a Z. ,y,t V'G��
r
DATE: PERMIT// 0Ifo
MOBILE HOME MODULAR HOME
FOOTINGS — FOUNDATION _ BACKFILL FRAMING
N/A YES NO
1. foundation support, pier spacing oe
per manuf. .................. _ —
2. anchoring per manuf. ...............
3. water line shut,off ...................
4. sewer line support ®4 feet ....... _
5. heating crossover (dblewide) off grd. le."
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 # Serial #
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES ---'NO
Comments: r
EEC lls SCa�'l /A G�Ilej
!�r Cd AJ 42 /.s> t e
on
RE EIS E®
2 JAN S 2004
7 TOWN OF QUEENSBURY
S" BUILDING AND CODE
Aced
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0.5/11/2013- 00:12 FAX l 001
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19C91 /03 .
CUSTOMER INFORMATION
i LAST*tA.lytE rmTNAME. HOME HONE WORK PHONE
Ruggiero Cyndie (SIS) 668-5816
COMMU IT iNAME STREET ADDRESS 8c LOT LOT N_ COMMUNI'rY P NEK
Homestead V"iffage LOt#12 i Y2 s Carp
CIiCr 9l'ATE ZIP COUNT 1A5T OF.SLRIAL
�}ueembu F=804 Warner
SOME INFORMATION
STk"IL5 AMDER llM'C WHO'S fNVENTOttY SA S a NTER Vt�TE MODEL I9
Salt! Used . A.G..L I-Sales 1, Used
YEAR MANU1+ACri,iRE t SERIES MOUELI# —COMPLETE SERIAL
19$3 Huffy Paris 7 —
_ t 01HP10288
SINGLE OURI.El1' IP E WID'Ctd ENGT BED uAXH COLOR FLOORED WITH
Single I14 70 L..J r S/4r Yerfow lv/A•
�OM SHIP.DATE PItliYidWS OWNER ifA'Cl:'COOK OVER.
Brack\Strait 09/19/03
NI:t!'iioME AS144NG PRICE FOOTEASMAO A�MT PARK PACKAGE USED HOME SELLING:PRICE
viz z29.0a ( $d.00. a.00 $0.00
RECEIVED
JA►v 2 6 2004
TOWN OF QUEENSBURY
BUILDING AND CODE
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