2004-576 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. P20040576 Date Issued: Tuesday, December 19, 2006
This is to certify that work requested to be done as shown by Permit Number
has been completed.
Tax Map Number. 523400-309-009-0002-001-000-0000
Location: 200 LUZERNE Rd
Owner. HOMESTEAD VILLAGE L P
Applicant: HOMESTEAD VILLAGE L P
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 Enforcement
Planning Board or Zoning Board of Appeals.
�r TOWN OF QUEENSBURY
742 Bay Roads Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040576 Application Number: A20040576
Tax Map No: 523400-309-009-0002-0017-000=0000
Permission is hereby granted to: HOMF,STFAD VT[J,ACTF, L?
p
For property located at: 200 LUZERNE Rd
in the Town of Queensbury,to constructor pl4ce
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 LP ,
4294 ROUTE 5 Mobile Home In Park $18,400.00
Total Value $18,400.00
CALEDONIA, NY 14423
Contractor or Builder's Name/Address Electrical Inspection Agency
i ,
ij
Plans&Specifications
2004-576 59 ALPINE AVENUE
840 SQ FT MOBILE HOME
$29.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, July 27, 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 T wn o ueen u day, July 27, 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
File Permit NoD
��7
Address:
Name: 1 4-
06
(D 9 -
Fee Paid
6C<r,-Cz
n xE CEIV
Phone No. -,2,-(C, 0 .JUL 2 3 2004
Property Parcel Information
,y Owner Information TOWN OF QUEENSBURY
BUILDING AND CODE
Name: �Awr_ Proposed um of Placement:
Property Location: 9 A1.0--itly-0-1 RYL
Address: 'Roan, Avenue
Name of Mobile Home Park: L��4mD
�k
(if applicable)
Phone No. Tax Map Number L% I
Mobile Home Information Zoning Information
Approximate Value of Home: Sj'�p -
Zoning Classification:
New Home: (IF No Size of Property: 6(, ft.by 123 ft.
Replacement Home: es No
Size of Mobile Home: ft. by ft. Existing buildings: X C)
Setbacks: front yard `3 4) ft. ; rear yard ft.
Singlewide: ✓ Doublewide: Side yards ft.and ft.
Number of Rooms: (exclude baths) t
Number of Bedrooms: a 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 W
!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.
2. Name of manufacturer. r,
3. Plan Approval Number.
4. Model or Component Designation:
(New Home ONLI}
5. Date of Manufacture: /�/ o J
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
1 authorized by the owner.
Signature:�s
owner,owner's agent,architect,contract
Special Conditions of Permit
By.
Form: 11/19/1999sh Code Enforcement Officer
cn
' (9 W
CD Z
t� v- o
J p L.�.
LLJ
j `_ t„ C� o = W ci)
:5 ID 0
s C L O
•b L� 3 1 (t7 LU tC QCD
CDE c ci dui �F Q�NQ vG QG
m co uj U C C2U Q
Ott)9rFD I O
V,06
EfRI AF
jw Fg�F�
r
i- ------_1,srtcE55 t.,jrjry ------ ----- •h1
r� F=:I
7
f .`+.� IUSrUt CFD 1u I f 1 sn y Mh=1&24 3E
RN.U'Jtla9.4 fL
( IEl JPFA=735.13 il- t t,ry�� � I�'C 4fJ(Sxf.i3 SI tdt J�Pl al si �' I
S41 U(H1�Its6F sf, U—J ED� KT.�IOS1:1191 s.0
® �fJ t4htaS0S s( _� �. YfY 1iBT=?,tJ y.l
—
J— .J
iTA FILE .W92E
SEC.
ILL <•iS
_ �]vTslo s
-7ANDARD SYSTEMS <�> LOCKING HARDWARE NOT PERu9TTED. )11 341 x s52
-- -----—----— 11121 13441563 0
+-I 115 34 571 �+
p -0;000 h-rel E-5p-9.2,3.4.5 5• DRAY)i EJY: :REY WJND lom--)
n-►las E-I Do-1,2.3.4,5,5,7.8.9.10 �25 56 ssi a
73E 52 812 F DAh�JJ1b o?i 5 two?ZOxrSils
o E-150-1,7 1d3 581 sH6ET
-1-5$ InSO C E—?aQ=1 163 595 Box L£NGTH DMRIPT101s DRAW)UG NUMBER
{ • vEA Alc;Kt GDyy,u,"ON AEob.W NEii 704E 3• 171 g$5
ssa 604 5914-&-Wlt SC?a1-C1
11/1 01/2013 21:37 FAX HOMESTEAD R002
2i001
39345
------Ir— -- TIrr HOMETTE CORPORATION
SOLD TO: AFFORDABLE GREAT LOCATIONS INC 99 HORSESHOE ROAD
4305 ROUTE 5 P.0—BOX 220
LEOLA PA 17640
CALEDONIA, NY '14423
(717)656.2071
PRODUCT NAME CODE NO.
SIRCHFIELD 1 49
FINAN ED B ;CONSECO FINANCE$ERVICINC3 CORP SHIP TO; AFFORDABLE GREAT Q)-CATI0NS,IN
Q
PRESOLD 4292 AVON-CALEDONIA RD.
P 0 BOX 940 CALEDONfA, NY 14423
402 ALPHAREw7TA,GA 30009-0940
Approval ikiLt.j'Narrie Approvaf c*6
KATE#1 728527 4611 wwlb
FT,irp, lan rms Qty. Option DeScrilpffon Amount
SKYFIN 3 15"WIMMMY bHu I I EKIS
Date Date Shipped How Shipped
order Date UFline Date I 30#ROOF ZON E124"O.C.ROOF
P 06/2(612000 HEN=RIETTA05124/2000 06/1912000 1 MAKE HOME 2 Elr:DROOMS
U 1 STIPPLED CEILING
Ord.,
DOM (HUD Tag,Date Gust. Order No. Date Tallied
0611 912000 AMY1908 06126/2000 6 VINYL WINDOWS W/GRIDS
f�N,70, 1 BEACON HILL GRANDBERRY
,;PF-L:N
C701 CT 1 16 CUFT FF REFER
I MIMS-070 GAS FURNACE
I FURNACE STACK EXTENSION
49-17-0 1 SO'x--14' 1 30 GAL ELECT-WATER HEATER
1 EXTERIOR FALICET-PRINT
gip;............. `[�ECEIVEI
CK-C—ATH THRUOUT 5 WATER SMUT OFFS TIO,
SIZe WX 14' Overall length excluiles aPPLO—Ximaltally fc�OT:foot hitch. 2 BEDROOM CEILING LITES
TECHNICAL INFORMATION I LRG,WH(rEE PATIO LITE FRT,
�lflz'WCWOD ILVCalbrr R-Value Approximate Type 2 PHONE JACKS:SEE PRINT
Thitkfmus I PORCELAIN LAV SINK
cailing R-33 -10-1/2" Min. Wool QUEENSBU1
VIVI R-1 1 3-1/2" Fiberglass I OPT.GARDEN TUB BATH TOWN OF BUILDING ME)COD'
Floor P-1 9 6" Fiberglass 1 TUB OVERDRAPE
Rcof Lcaa Wiricl e Heat zome 1 SHELF AT W/D AREA
30 PSF� Z014E 1-15 PST- I WASHER/DRYER WALL
H.U.D.t1--,@11cation Label NumBer(s)
ULI-507994
VOLUME INCENTIVE PROGRAM
1,11W1ZWV0fGAhajjCPM@nQ Prozarr;aVplleskci this Invatce.For full Information
(SUPPIlmallial we'ta Idl VIP Skyline Corpofilibri P.O.Box 743,mkmft IN 48515-0743
TOTAL PRICE WITH OPTIONS
FRF: GRT 211
SALES 'PAX 224
NYMHA DUES( 232
NOTE.Sumu imoninU Hera,hrfudiq3 1161%.W1104?ltt,!Ixluk",�Prir)gp,LIM br.,Akci Brc raus cl sitar cararui
RVITUCLU11.
NOTICF:L:lt%S.0flJnAK(1,3,11 tar en.-rchandisc.coygract by this invalc cs ri e dcot=Mulliulo GRAND TOTAL
payrnetll mu idire w vwrw do=r not poem until=eti v&,,vw-.racei*L�d by LZSS DEPOSIT
The und,.raajiacl namy zcknow1-3dg&s delivery and zicceptance of BALANCE DUE
NOTICE TO F)EALER;Whan zi=tiplirig cletivary,of this shipment be sure to exem ne tiginc carefully WWI nave Shortagr.or
(SIGNATURE) DATE 021maw notef;on ywl;,r(;hw;x cut shool whk&must be mqunied by uie armr.We cu.naa�vssvnw euspoAsivilty for lVss of
dmrmgo to horrici.In trurmll.unl&4s(MIM140 Of ithanISCil Of Carnage IS rrincla wrierip:topting delivery.
WZWK RETURN THIS SIGNED ACCEPTANCE TO SEE CERTIFICATI UN K V—
'l�:.�r C-1.;'"..,-.l'
I,f�.. N�.
.N' c �.".,""j
�I
�.�7-'.-:�y;.��Fg..,"'-
;�;I.�� "P5.'�-Fff'.-7'l l.t�-.'"7'.
�!_
V.4,
t�,"�";.H..
"1,"-�.�t�-g-_'�'
-."..*'-�.,. 'r"A --�
-s V - �q�' �,, 'ZI'_.I. -'4--".l..-'x A "-� :3 .''. ? M. 1
'..
.;'�.
,j .� ,p k_= ,Zk % j, " � PI ��,!X=' 4Y-- _ �
11
'-.
;.,
;"..
-,.
'1.I'I
�.�t
." .4 , ' R �vw � "' , ";L>, '"-
.6I
,1
"_1.5
*�
,z;� 0l -.; . n', X ;k,�Lt' :4 " —'` ' ' " ;
,
.".
..
1�i.-�....�
...
-
'�.
'....:...,..X... ��.f..-
.,
.
"
1-
.�I..-�
11
.1.
:
"�... 'j..iI.-
,.
..."....
Ax,'
N
���.''-�.,.'..
�_-t
M.'
,.-
'
'
...
f',....�
�
�.
...
...
,
,
.-
_.
.
-
'
I.
.
�...1
-
I;i
Ii
...
'..�._.-..7..
�.
.,t%-....,..
.
.'.
I��
I
a�
!.-..1..�I.
,1
:
-
;
b'
...z_
I�
"
-.I.b
,,I16I
..:
I
�.dI.....-..
"
.1.
1..,
—...�-4-..
.�
-b�
*-.
-
.,.
�
J,
'
;
.
I"
...
"
'l
.:
-
:
.-
;
,V
l.-.
b.
�...".
—.
.:.
?,'
'.-�.
..
'
.
.
.-..
..:..?
.
:.m1
'...j'.
-
,
�^....
.'
b I
..--
:
�
_
-I-,-
:
-
--.,'
�....1I
..'..
;.
�i.
�-
�--�
��
;
-..
�
-..
.I
..
.*
-
.
1:
.I
-
.-:.
�" " E - _i -*' t ".�" '�41._", " � ,, � I'" l-� ;� N ' , i3 -
... -; �;' A�-?25 ''Al � "
- "_ MX. 1 '!�T.A P W. . i .. �
..I `- V- ". .. il'
,. s - —l, \ ;,. \" " - �- \ �' �s ,-S 'a — -4 4 23" -d t6N C F I IN'� F17I . . t i� 7 " � .�F .� �.S 41 ,. 3 2
I I
�! T � ', f-� ; (1 '"r6
Isteck,8 ��1 �I - V•
( i- i � 1,�� i t� [�I,� I \1 � \ ) � I'.
�. - .f ' e,, J C"
2:8 � . 4.; ,;� 3 1q1';.' .q. ` T ' _" I � �1 1�U'zl I. . l 1 , ut iY41�q 3 � t i. 0 c I . ,�L �2 �-?
1� - :� . ieq:' m M �, j , � A. . � . .LI1 - -, 17C1 ':Z ,C .� : "' -� �:
�� �l c�. . ;.1 2 .
�� 0I' l *� : tk� ,I 66 65� : � 1- �I Io���./f '_— .� 7 ( �
.� ;'_-��� , 1.
. I � L
4 ", � � " noP " - LL
N ` wC
____ B.v � " k1 . 1. � I . L.- . . . . )I. 1,r
'5� �- �' � 881? f : . (- .I I,. i; If,- i�
. 7 " 1I . -1 , q2 f7 I16 4" / I " 4
I 6. ,'c,
' �" e'' 1�z I j I J 1 11' � � ) 1 ) I I ) 6
1 . 2 3 l '. . 1 .-I I I' /1 t ) 9� 44t1"Ve
`Z m l� _ P
. :�
1* , " � ,�" �',4 ? - — -o
" v e ,
. ..
1 \ 'I * . _, "� '. . , I �l _
7 1F- . ;:," t . 1 Y �" � I rI I �16 ke �I -Z 3 qJ . . _ � f . A . ) % .,, :21 '�y . ' , I,,. ' 1 � .
.' , I t : ' 1" ; 7' 4�z— - v ) �6 , ,u z IE 7
;� P, ;
, 15
I b 14 )4�- I 6Y ; 4 f ,� I� 0 ).1 7I. 7t q
.' ..
A
..- .;-1 � I
. .j
. .
'..I. r
...
_
..._
.
�
..
i'.
._'
'
.-l...
w_
-....
-
-
,-
--C
('If�
1!
I ;ib.:...:,..'.�..i.Ij -.
'.�..."..
., �
... ...I. . .....
.
"."`_\N-1.. ..
. Y. 1, )
I"
:
'.I' "
FINAL INSPECTION REPORT
..MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVI DEPART: INSP:
DATE INSPECTION REQUEST RECEIVED:
NAME: i I
LOCATION: I 1'
DATE: 1 Z PERMIT#
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 ........................ — —
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 G/p V�p,c5 /v,,
Pc_G--+t�G— (fo nf7'��— .i�-ll� (CIF►=t �'
A-TZ—L-i .
FINAL INSPECTION Repoliklr
MOBILE / MODULAR
Town of Queensbury
Building &Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART:l;� INSP:
1
DATE INSPECTION REQUEST RECEIVED:
NAME:
LOCATION: AJ��
DATE: 6 `� PERMIT# J 6
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 (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, 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 H Serial 9
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O. YES NO
Comments:
L--o�