2004-081 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: P20040081 Date Issued: Friday, April 16, 2004
This is to certify that work requested to be done as shown by Permit Number P20040081
has been completed.
Tax Map Number: 523400-309-009-0002-001-000-0000
Location: 4 WINDSONG DRIVE
Owner: HOMESTEAD VILLAGE L P
Applicant: TIM & CHRISTINA DICKSON
This structure may be occupied as a:
By Order of Town Board
Mobile Home In Park TOWN OF QUEENSBURY
Director of Building&Co Enfo meat
BLDG. PERMIT NO. 2004-081
a
i
APPLICATION FOR A TEMPORARY'CERTIFICATE OF OCCUPANCY
A. TEMPORARY CERTIFICATE OF OCCUPANCY is hereby requested for the property
located at; /�,� , ) C� %abuts Q iefaan
for the following uses:
DATE SIGNATURE OF APPLICANT
TEMPORARY CERTIFICATE.OF OCCUPANCY
The TEMPORARY CERTIFICATE OF OCCUPANCY is hereby W.AP ROVED
( )DISAPPROVED
_ with.the following conditions: Ce;Lt �ccu e; �$ Qccupaney to be issuedz
upbn compteti.on o6
I) C ompt ete Anch,ot ing ;
r
71
`�.
TEMPORARY CERTIFICATE OF OCCUPANC FEE- )$1 0. v P 0.00
received on
A `
Date.of Issuance Director of Bldg. & Code Enforcement" '.
THIS TEMPORARY CERTIFICATE OF OCCUPANCY EXPIRES ( DAYS
FROM THE DATE OF ISSUANCE. _
NOTE:,This .Certificate is NOT VALID unless signed by the Director of Bldg. & Code
Enforcement or his designee.
r' TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040081 Application Number: A20040081
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: TIM& C 14RTSTTNA T)TC;KSON
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 $22,000.00
Total Value $22,000.00
CALEDONIA, NY 14423
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
A2004-081 TIM& CHRISTINA DICKSON
LOT 4 WINDSONG DR.
1987 MOBILE HOME 980 SQ FT)
$60.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, March 15, 2005
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the n of Que nsbury; Monday, March 15, 2004
11
SIGNED BY for the Town of Queensbury.
Director of Bu g:& de Enforcement
Application for Permit— Mobile Home
Town of Queensbwy, 742 Bay Road, Queensbury, NY 12804 (518) 761-8256-
A building permit must be obtained before placement of mobile home on parcel. No inspections will be made
until a valid building permit has been issued.
Applicant In
Office Use
Name:7�Vh C{,rsst��ct �/C'J��r� , File Permit No. D� 0
Address:� rl/rsc�i�q �i✓e�
Fee Paid ,
l (J�1 18 Reviewed By
At
Phone No. J_/k' ' ScP"/ 030 —_..._..__.._».._
Property Owner Information Parcel Information
Proposed Date of Placement:
Name: c/U/lI G to -)
Property Location: WIn(J ,5 oh
Address: ltoaa,Street,'Avme
IV Y Name of Mobile Home Park:_11.1-loa-04ha�t/f/�ei
_.. (ifbppl C4Wd)
Phone No. _ 2? 7 o� /00 .. _:.
• - Tax Map Number•
Mobile.Home Information-_ :Zoning.Irr ormation: ::
Approximate Value of Home:$ R;�C)00 �r
_- . .... ...RECEIVE.
,�,, a' Zoning Classification: BAR I D 2004
New Home: Yes � (�
Size of Property: ft.byTOW NtF QUEENSBURY
Replacement Home: N90 BUILDING AND CODE
Existing buildings: t>g V_SL
Size of Mobile Home: ft. by ft.
Setbacks: front yard fh; rear yard &
Singlewide: Doublewide:_ Side yards &and ft.
I Number of Rooms: (exclude baths)
Number of Bedrooms: ,R 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 I SIZE&DEPTH Water Supply: well or municipal
Piers s
Runners x Is Septic Permit Required? Yes or No
Slab s
Further information requested on the reverse side of this sheet W
Name of Installer or Mobile Home Dealer-
Address: 9 -
Phone No., /b
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
1. Insignia serial number. gC2-9cl
2. Name of manufacturer ! O
3: Plan Approval Number:
4. Model or Component Designation:
(New Home 0AE1)
5. Date of Manufacfure:
`7 _....
AFFIDAVIT.. . -. -
_.... 'Town of -- —State Of-Nd*Yoik -_ _.. .
--- -. _. Qneensbury. _.. .
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
Form: 1111911999sh Code Enforcement Officer
FINAL INSPECTION REPORT
-MOBILE / MOOLILAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-82 , .
ARRIVE: DEPART. NSP:
DATE INSPECTION REQUEST RECEIVED:
NAME:
LOCATION: ] t'
DATE: / PERMIT
MOBILE HOME MODULAR HOME
FOOTINGS _ FOUNDATION - BACKFILL_ FRAMING
N/A • YES O
1. foundation support, pier spacing
permanuf. ........................ _ _
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
or
OKAY TO ISSUE C/O.,,\ YES NO
Comments:
FINAL INSPECTION REPORT
MOBILE/ MOOULAA
Town of Queensbury
Building & Code Enforcement
742 Say Road
Queensbury, NY 12804
(518),761-8256
ARRIVE: DEPART: INSP:
DATE INSPECTION REQUEST RECEIVED:
NAME: l S f J A
LOCATION:
DATE: 1 PERMIT#
MOBILE HOME MODULAR HOME
FOOTINGS _ FOUNDATION _ BACKFILL_ FRAMING_
N/A YES NO
1. foundation support, pier spacing
per manuf. ...."....................
anchoring per manuf. ...............
2. _
O. water line shut off ...................
4. sewer line support @ 4 feet .......
5. heating crossover(dblewide) off grd.
)dryer vented outside ..w................... _
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:
FINIAL INISPECTIONI REPORT
MOBILE / MOOLILAR
Town of Queensbury
Building & Code Enforcement
742.8ay Road
Quee18) 12804
61-8 56
ARRIVE: DEPART: INSP: Ri
DATE INSPECTION REQUEST RECEIVED:
NAME:
LOCATION:
DATE: PERMIT# C/d
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. 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 .. �1�. —
17. variance required ..................... —
18. data plate okay — _-
19. mobile HUD seal okay ..............
Model # Serial #
Manufacturer
Date of Manufacturer
OKAY TO IS E C/O.P YES NO
:'I�w
Comments:
(�° -UAC�
Cow P� C- A I-) `" vr21 pocp
d
FINAL INS1j)ECTION REPORT
MOBILE / MOOULAR
Town of Queensbury
Building & Code Enforcement Cl+{��s;ti"34
742 Bay Road -2)`����,� R/
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART:, . INSP:
DATE INSPECTION REQUEST RECEIVED:
NAME: LV
LOCATION: 'J 2- (Z7,
DATE: PERMIT #
MOEILE 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. 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 ....................... J —
19. mobile HUD seal okay ..............
Model # --Serial #
Manufacturer
Date of Manufacturer 1 -2— 17 O
OKAY TO ISSUE C/O YES V NO
Comments: I,,/ T o SA)'
Mar'_ 1 04 04: 24p Valued 518-792-5606 p. 2
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FOAM IN, ' OTICE _
u +no
A 15 ARN(n T :� BE CO,
AL B4 - �•• - ' e am o . .
TOWN OF QUEENS80 BUILDING DEPARTMENT
Nff10EBaste on wi limited examination
cornpiance with air commentsshall not be construed as indicating the
KRAF'T'Apo'NSaATION MUST BE plans and Wb the Bull are m full
COVERED BY'VON-COMBUSTIBLE BARRIER `���ce`"'�'�'e Building codes
of New York State.
NOTICE
ANCHORING OF MOBILE HOME
FRAME IS REQUIRED PER
MANUFACTURERS SPECIFICATIONS
TOWN OF QUEEN '+RY
BUILDING &NCO p
4
REVIEWED BY
l0 DATE
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