2004-962 FINAL INSPECTION REPORT
MOBILE / MOOULAR
Town of Queensbury I o
Building & Code Enforcement I
742 Bay Road
Queensbury, NY 12604
(518) 761-8256
ARRIVE: DEPART:' INSP:
DATE INSPECTION REQUES,I RECEIVED:
'n�L
NAME:
LOCATION:DATE: PERMIT MODULAR HOME
FOOTINGS FOUNDATION BACKF L.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 ®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& W-C9•.... YES NO
Comments:
�y
L INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road �� r
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART: ` INS
DATE INSPECTION REQUEST RECEIVE
NAME:
LOCATION:
DATE: PERMIT
Y40BILE 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 ................... Y
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 ........ _ f
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:
V\I)L- t-�) .
_FIf9AL IIVSPECTIOIV REPORT
e
MOBILE: / MOOULAR
Town of Queensbury
Building &Code Enforcement
742,Bay Road /
Queensbury,. NY. 12804
(518) 761-8256
ARRIVE: DEPART];
INSPJ /
DATE INSPECTION REQUEST RECEIVED:
NAME: e
LOCATION:
DATE: D PERMIT/
MOBILE HOME MODULAR.HOME
FOOTINGS _ FOUNDAI ION — .13ACKFII L_ FRAMING
N/A : YES fro
L foundation support, pier spacing /
per manuf-
2. anchoring per manuf. ............... _
3. water line shut off ...................
4. sewer line support a 4 feet ....... —S. 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 .........
If. 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 seat okay — _
Model # Serial #
Manufacturer4kLU
� N
Date of Manufacturer
OKAY TO fSSUE CIO YES, NO
Grn�,Pce W- ',�
Commen
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FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: 3'* DEPART: INSP: I
•� t
DATE INSPECTION`REQUEST RECEIVED:
NAME:
LOCATION: r
DATE:.,, J PERMIT N
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION BACKFILI. 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 0 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 N Serial/ l�1'`7��l•'fv�Sa
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES 1NO"
Comments: jo
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TOWN OF QUEENSBURY
742 Bay Road, Queensburp,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CE1P%.`_Lr1FI CATE. OF: O CCUP-ANCY
Permit Number: P20040962 Date:Issued: Wednesday, September 28, 2005
This is to certify-that work requested to be done as shown by Permit Number P20040962
has been completed.
Tax Map Number: 523400-309-009-0002-001-000-0000
Location: 717 ADIRONDACK STREET
Owner: HOMESTEAD VILLAGE L P
Applicant: KEVIN & SUSAN DEAN
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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040962 Application Number. A20040962
Tax Map No: 5.23400-309-009-0002-001-000-0000
Permission is hereby granted to: KEVIN DEAN
HOMESTEAD VILLAGE L P
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 $14,000.00
CALEDONIA,NY 14423 Total Value $14,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2004-962 115 Adirondack Street, Homestead MH Park
Kevin and Susan Dean 14 ft.by 70 ft.used mobile home
$33.80 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,December 16,2005
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the f Quee bu rsday,December 16,2004
SIGNED BY kbk for the Town of Queensbury.
mY
Director of Building&Code Enforcement
Application for Permit— Mobile Home
Town of Queensbw y,.742 Bay Road Queensbury, NY 12804 (518) 761-8256
A building permit must be obtained before placement of mobile home on parcel. No inspections will be made
until a valid building permit has been issued.
Applicant Information
o�
Office Use
Name: ,Ui ►'1 Nar) _ File Permit No. aoG4-9 0�
�� RECEIVED
Fee Paid��
Address: f Yi 1/`� ✓
�� �_
EC 1 4 .2004
ytS Reviewed :B
y N OF QUEENSBI RY
Phone No. Lai `� a�� ceu AND CODE
Property Owner Information ? Parcel Information
Name: ,�(� Vl Proposed Date of Placement: 1A: h at
-� --- Proper Location: S xaAddress: kj('ra7 � VC�-{-
eme
,20 S cd4 . M q 1 Zgv Name of Mobile Home Park:�mes4 End ` P lace
_.. cab _ _. .
Phone No.
t aP,p: e _ o1CU
Tax Map Number: /
Mobile.Home Information :Zoninglormation
Approximate Value of Homer$
Zoning Classification:
New Home: Yes
Size of Property: ft.by ft.
Replacement Home: Yes No
/ �7 Existing buildings: 1'l(;�..Q.
Size of Mobile Home: J-7 ft. by ft.
Setbacks: front yard &; rear yard ft.
Singlewide: f Doublewide: Side yards ft.and ft.
Number of Rooms: (exclude baths)
Number of Bedrooms: 3 Accessory Building(s): circle
Number of Bathrooms: a
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 x
Runners x Is Septic Permit Required? Yes or No
Slab s
Further information requested on the reverse side of this sheet W
C
Name of Installer or CL)OSCLIt
bile Home Dealer !�! au Y � G pub-S
Address: a"
Phone No. 117 1 Z
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
1. Insignia serial number.
2. Name of manufacturer. i+i.VY tJo VVi es
3. Plan Approval Number:
4. Model or Component Designation
(New Home OWL I)
Date of Manufacture:
_. AFFIDAVIT-
Town of .
= -—- - Queensbury •---:.--State ofNdWYoik-
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 BUELDING 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
i
Special Conditions of Permit
By
Form: 1 111 911 999sh Code Enforcement Officer
Kevin & Susan Dean 2004-962
—Tt5-�drorndack Street Homestead MHP
W
---TOM OFOUEENS
BURYBuILDING
Based On Odr DEPARNENT
-------CDM "ft'*_exaMina#on----
Gon-WIMI our comments snit,
not 'a"stilted as
indicating the
Plans and specfflcauons
are in-mn-
the Building Codes
it
Of New York State.
Ir
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