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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 :� ¢ - t 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 Ic aOON� mow' o ++ \ [ LIVING 1 4! -• piNiNG 1 ��'� x 1z1s ��- •�7� 81:C1#2 BE p#3 � < < • ,'yn u V 41� w,z r. .Y r • 1 1 1 ' f.. t� On 1' t '�•'�t r:T,3 rl ry , " M� _ • .. :G::Ye.:f,e>r r::=`�.av! .;,t" �y�Se '�^' ,'1:". �fir• , 0': I J _ S t 'r .7'"n••^�.J,r{-�r•',a'• .1'h'.. ^r�w ~1'••�'4�'« ,�h�:: ':!?;.rh.,r.:• �.t _, a2\+:, R:,'• � •fit::s.,� q �7.t4�S . r .fit. P�� ( i' 5 :�. �• ]]' �.a % I wl WQ 1 t ~•a' t'c. UI- .r. u•- YI I i I 7 C -I _fr.7 1 G l'j goof! 1 // r,9 1. ;� �r .x t 1. t lt: E r. *S by 5 ••s t� - - LOfro s a f yi 1 q '•f 7 4. 4i� t•111 � ,g,:.,:' ( j ( '�� ��,. d:. fir•� 7 wR`.. 'F i� hir.:� 1 S• 'I> 7 I s f I' ti o I i _ •mow n 1�. £' ^t 1 •( r. J y ::a• : [!1• off :) +.a f• 5r. `M r,[ it :7 {h CX• r rt �N .1. .a• I: s 1 i' r'ry .i. . ..:..... .::. . J •J�i; •'aq'. .1 9..,s i a J z '9. C , 1• r. 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