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2012-106
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: P20120106 Date Issued: Thursday, August 23, 2012 This is to certify that work requested to be done as shown by Permit Number P20120106 has been completed. Location: 158 LUZERNE Rd Tax Map Number: 523400-309-005-0001-001-001-0000 Owner: D&G MANAGEMENT LLC Applicant: DAVID CLOSE This structure may be occupied as a: Mobile Home In Park By Order of Town Board ll�Gq l�S 1� n 1 TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the property 1 - 11 owner of the responsibility for compliance with Site Plan, Variance, ori other issues and conditions as a result of approvals by the Planning Board Director of Building&Code fo cel nt or Zoning Board of Appeals. 0111` TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 11, Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20120106 Application Number: A20120106 Tax Map No: 523400-309-005-0001-001-001-0000 Permission is hereby granted to: DAVID CLOSE D&G MANAGEMENT LLC For property located at: 158 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: D&G MANAGEMENT LLC Mobile Home In Park $50,000.00 PO BOX 2488 Total Value $50,000.00 GLENS FALLS,NY 12801-0000 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2012-106 42 Sugar Bush,David Close 1,596 sq ft Mobile Home,Redman-New Moon $50,000 value $191.52 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, March 26,2013 (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 To n of eens 4 , J . ', arch 26,2012 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement OFFICE USE ONLY '< ,.,... -E-4- 1E, • ._.....y oo- r • TAX MA ND. ' 5_/ PERMIT NO. - /O� DATE ISSUED: i Date 'I 91.Sa ;� . �� `? 2 � 212 (. PERMIT.1E I i APPROVALS: ZONING TOWN CLERK , • $ $ TOWN OF QUEE`oBU ;( au1�91N� _�9DU ; MOBILE HOME -APPLICATION FOR PERMIT: 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 Property Owner Information t Name: PAM C l©S�, Name: Dar\ O Address: 1/ V-i/Ck..L44 4,1/ /eC1 Address: n( c' /-'L1 Int kt IS m/7-14/L MA ) N '/ /a '.3& Phone No. /C-7 W— a q Phone No. J t 4 5P s P Parcel Information (� Proposed Date of Placement: '3,ail/ Property Location: %a J Lf q 0v' ��{S A Road,Street,Avenue Name of Mobile Home Park:N0) tom ' (A)Inds (if applicable) Tax Map Number: Mobile Home Information Zoning Information Approximate Value of Home:$ 6-0,00 0 Zoning Classification: New Home:, Yes ❑NoQ s/ Size of Property: ft. by ft. Replacement Home:�Yes Cl No /,J 1 Existing buildings: Size of Mobile Home: 491 eft. by JAI ft. Setbacks: front yard ft. rear yard ft. side yards ft. and ft. Singlewide: Doublewidee:T� Number of Rooms:(exclude baths) Accessory Building(s): Number of Bedrooms: Number of Bathrooms: a Detached garage:❑1-car El 2-car ❑ car 0 Gas Fireplace DWoodstove p Wood Fireplace Attached garage: E11-car 02-car n car Foundation Support: Storage building: ❑Yes El No Type Size & Depth Other: Le x to deck- Piers eckPiers Water Supply: ❑Well ❑Municipal Runners ,�,/ Slab Is Septic Permit Required? ❑Yes Io Continued on page 2 MaTown of Queensbury• Community Development Office • 742 Bay Road, Queensvury, LV x Lan)* Name of Installer or Mobile Home Dealer: t/ i/tie. / //C i s C Address:/57), 4-IL? P 56.)04 t Ni Phone: 57A2 7/-3 � Complete information below found on a"Plate"or"Sticker"which is affixed to the mobile home: ✓ Insignia serial number: /c -oO U - A 00/I9 9P i9,f3 _ ✓ Name of manufacturer: t?e chvl aft ✓ Plan Approval Number: ✓ Model or Component Designation: N€ t r oO n (New home only) ✓ Date of Manufacture: ^.!i!L!11:.•i!:!i!i!:!t!-._.....!i.!:!:!-.!L•i ISK_i!t!i:!�:5:!:!:.:_:^.!:!:]i.....i_1_i........_:.i_l'S.i.1Si.i_•1_f!i:ili!i!i!to AFFIDAVIT C K Town of Queensbury State of New York County of Warren s 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 a J that all provisions of the BUILDING CODE, the ZONING 6 ORDINANCE, and all other laws pertaining to the proposed work shall be complied with, whether specified or not, and that such x work is authorized by the owner. , y Signature:IU wner, Owner's Agent,Architect, Contractor K v K G SPECIAL CONDITIONS OF PERMIT By: i/ L/4/J /� Code Enfo ment 0 icer s Town of Queensbury• Community Developm- t Office • 742 Bay sad, Queensbury, NY 12804 Queensbury Building & Code Enforcement— Manufactured / Modular Final Inspection Office No. (518) 761-8256 Arrive: am/p art C J 1 /am/pm Date Inspection request received: Inspector's Initials: NAME: PERMIT#: 20 2- LO LOCATION: A2. DATE: Manufactured Home Modular Home Footings_ Foundation_ Backfill_ Framing Comments: Yes/ No NIA Foundation support, pier spacing, J Per manufacturer Anchoring per manufacturer 2'from ends Water line shut off Sewer line support @ 4 feet (71 Heating Crossover[doublewide}off grd. Dryer vented outside Skirting ventilated 1 sq.ft.Per 1,500 sq.ft. V Hot water relief valve piping outside Deck,porches,steps, railing 1// Fumace/hot water operating Garage Fire proofing /1/ Fire Door/Door closers plumbing Fixture/3"Vent through roof[Modular] Foundation insulation[if applicable] Smoke/Carbon Monoxide Detectors/Interconnected Final Electrical L� Variance required 1 \‘lLo 1Z� Data Plate okay Manufactured HUD seal okay Warranty Seal after January 1,2006 ‘71: Installers Warranty Seal 18"x 24"access or 22"x 30"attic access Vapor retarder under home 6 mil poly or other 911 Street number Okay to issue CIC or CIO[Temp_/Perm.] Model# Serial# (6ct434t Manufacturer 6-tr\A-# t�S�U ti 5 t- U) z)&k — \\--7_, Date of Manufacturer lg 'KZ) (f y°, /t, L:1Pam Whiting1201018uilding Codes Forms.Manufactured_Modular Final Inspection_03 04 10.doc • INSTALL NO. 16339 STATE OF NEW YORK DEPARTMENT OF STATE ONE COMMERCE PLAZA I ' r1 99 WASHINGTON AVENUE ALBANY,NY 12231 INSTALLER'S WARRANTY SEAL THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE MNEW MANUFACTURED(HUD CODE) ❑ RELOCATED MANUFACTURED(HUD CODE) n ,.11 �l,.)A. Manufacturer's name• J } T �} 1rn B. HUD label number: Iry 1D° a 3 pir5 ! 0 'i ! 0( Serial number: 1°f –19dr�-�7 `Al301 i le • ' • C. Retailer's name: Vii)u 1QCf�lj} 5 j / D. Retailer's address: ) 5 /e? R! . ' ' f /} fill/1 (1 N y 1-?2"-2 4) . _, E. Retailer's certification#: 4 R Z i 4ii yU S7C`! 7 �� , � •. pR Q Telephone#: �Bfe F. Installer's name: &V ` i of'ti/1 G. Installer's address: ,I6 7 i 1• 1 - [OA . ,-J:.0 A ed kV /2 72 <? ----k1 tallcc sa:4;r,ific:ation,.t'.� +N T'4/)LIQ) Telephone#. —.+ —A,4a110, ' 1. I. Date installed: Ai ?1 6/1-- Municipality issuing bljlding permit: �1 '!h t! O //�� qgitey,Town, Vlla�e) J. Cusgn er name and physical address (911)where home is installed: of ,..1Y u- /tJ 5 ( t1\5 bI s' 4Y Lf f 2,!;i2 Cl ,NewYork. 1J1,r/.-1 C j9>f 1 ' r By attaching this SEAL to this manufactured home,the undersigned Installer of this manufactured home warrants as follows: 1. That the installation of this manufactured home meets the standards of the New York State Uniform Fire Prevention and Building Code. ' 2. That the Installer is certified as an installer by the New York State Department of State. The foregoing warranties are in addition to and not in derogation of all other rights and privileges which the consumer may have under any other law or instrument.The foregoing warranties are in addition to,and not in limitation of or substitution for,any and all other warran- ties,express or implied,given or made the Instal r,whether contractually or by operation of law. Printed Name of Person Signing Seal: t t,{C v e I.L" Signature of Installer or - Limited Installer: If you have a problem with your home,you should first contact your installer or retailer.If the problem is not resolved by the Installer or Retailer you can contact the Department of State at(518)474-4073. DOS-1680(Rev.03/09) Yellow Copy—Department of State White Copy—Retain for Your Records Goldenrod Copy—Permitting Agency Seal—Affix to Home