2011-023 TOWN OF QUEENSBURY
wors742 BayQueensbury,Road,Queensbr},N Y 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20110023 Date Issued: Tuesday, May 03, 2011
This is to certify that work requested to be done as shown by Permit Number P20110023
has been completed.
Location: 200 LUZERNE Rd
Tax Map Number: 523400-309-009-0002-001-000-0000
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
/L-I---
property owner of the responsibility for compliance with Site Plan, ,,,,N
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
FR 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110023 Application Number. A20110023
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: 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 $29,000.00
CALEDONIA, NY 14423 Total Value $29,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2011-023
1280 sq ft mobile home in park
$153.60 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday, January 31,2012
(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 Town of Queensbury; Monday,January 31, 2011
SIGNED BY <<__ . I • for the Town of Queensbury.
Director of Building&Code Enforcement
Iiiit. "1,
J /
i
?‘----2—/ OFFICE USE ONLY
-r AX MAP NO. PERMIT NO. - 02:c DATE ISSUED: .!:' "
l� ,�.
(2 , L ,
PERMIT FA—ID—a/4 APPROVALS: ZONING TOWN CLERK ,!/]it; I�
?���
MOBILE HOME— APPLICATION FOR PERMIT: .
__-0 Y
i
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
Name: f� )1N Pry ‘--<
k
Name: `r-) P( I�i
( ' ain u•e,
Address: Ho S- -if
U Ac.cjQ Address: f _t '�_ Wall,' -t_ I.
IL
gi .& iI. f Qu0v-A.�\(l.1, I IA L4 1 zSt2L-
Phone No. Li'SD— 9 c6 2_3 Ca t Phone No. 9 3D - 9 23 Le_A 1
Parcel Infor - L{ Our 15 0 LJ5° `74L4L_96 0 44. ',
i Proposed Date of ' ;ce--•-nt: >;- . - O Property Location: , Allfit 4 A. is __ •
Road, reet,Avenue
Name of Mobile Home Park: p,r--.Q_ c\_. (if applicable) Tax Map Number: =\--
Mobile Home Information Zoning Information `:k.-)
Approximate Value of Home: $UZq 000.00 Zoning Classification:
Ij
New Home: Yes p�ti S r'`'�s s Size of Property: ft. by ft.
wok/!for.L-A'
Replacement Home: Yes No ���f"-in Existing buildings:
Size of Mobile Home: 1 (. ft. by Sib ft. Setbacks: front yard ft. rear yard ft.
side yards ft. and ft.
Singlewide: 7. Doublewide:
Number of Rooms: (exclude baths) r Accessory Building(s): circle
Number of Bedrooms:
Number of Bathrooms: 'I Detached garage: 1-car 2-car car
Circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1-car 2-car car
Foundation Support: Storage building: Yes No
Type Size & Depth Other:
Piers
Runners Water Supply: well or municipal
• Slab Is Septic Permit Required? Yes or No
Continued on page 2
a,
Town of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804
Revised March 2010
x
(rI\c& / r 1 ce_
Name of Installer or Mobile Home Dealer: Mt--Yri- S CO's\\3 s
Address:Q-1 LE VoS' vsr\ Q Phone: —7 la-- .515
Complete information below found on a "Plate" or"Sticker"which is affixed to the mobile home:
✓ Insignia serial number: 'S ( y 3
✓ Name of manufacturer: � Dp�
model .► Gy 13
✓ Plan Approval Number:
✓ Model or Component Designation:
(New home only)
✓ Date of Manufacture: J c o2 .
.r:t'tt•.itLtitZtititiStrati•.itt•.{ttitiCLLS:210.a'.:tttttintiti%.4...{trtit..tt:!d.t.tititit:t[t:.i•.:.siLtst.ittttitt titr..itit:tf....a'.wtititittttti4..4t{a
AFFIDAVIT
Town of Queensbury State of New York
County of Warren
M
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. 1
Installer Warranty will be provided at time of Certificate of Occupancy.
Signature: ,
Owner, Owner's Agent,Architect, Contractor
•
t j
--ss.•trtr•.:t:t.--«�sz:srsrtnr-trs.-t:•.rstrtr.::.�-t:t:t:t:t.~.:tr-t.-s.-:rt.-s:t:tr•�t:trt:t:t::sut:•�-trtrt:t.-t:t:trt.�::rtrtrr•».r.:t.—».ttrtrtr-t:t.-ti±
SPECIAL CONDITIONS OF PERMIT
By:
Code Enforcement Officer
Town of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804
QuQensbury Building & Code Enforcement_ Manufactured / Modular Final inspection
Office No.(518)761-8256 Arrive: am/pm Depart- am/pm
Date Inspection reques received: Inspector's Initials:
NAME: VAX2-gikN— PERMIT#: 20 ` °2-3j
LOCATION: (settif --71,4-0-1DATE: 4 z(
Manufactured Home
Modular Home
Footings - _Foundation Backfill Framing
Comments:
Yes No WA
Foundation support,pier spacing.
Per manufacturer
Anchoring per manufacturer 2'from ends
Water line shut off
Sewer line support @ 4 feet
Heating Crossover(doubfewide)off grd.
Dryer vented outside
Skirting ventilated 1 so.ft.per 1.500 sq.ft.
Hot water relief valve piping outside
Deck,porches.steps,railing
Furnace/hot water operating
Garage Fire proofing
Fire Door!Door closers
Plumbing Fixture/3"Vent through roof[Modular]
Foundation insulation[if applicable]
Smoke/Carbon Monoxide Detectors!Interconnected
Final Electrical
Variance required
•
Data Plate okay
Manufactured HUD seal okay
Warranty Seal after January 1,2006
Installers Warranty Seal
qC5(t___
18"x 24"access or 22"x 30"attic access
Vapor retarder under home 6 mil poly or other
911 Street number s•tc2 ZIN6E5
Okay to issue CIC or CIO[Temp./Pemi.] •
Model# Serial#
Manufacturer
Date of Manufacturer
L:1Pam Whiting120101Building Codes Forms1Manufactured Modular Final Inspection03 04 10.doc
-INSTALL NO. 15146 STATE OF NEW YORK
DEPARTMENT OF STATE
ONE COMMERCE PLAZA
t � 99 WASHINGTON AVENUE
-• ALBANY,NY 12231
INSTALLER'S WARRANTY SEAL
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE
0 NEW MANUFACTURED(HUD CODE) ,J RELOCATED MANUFACTURED(HUD CODE)
A. Manufacturer's name: j(40-6.
B. HUD label number: pc S 73Nlet, Serial number:V/iJL/I 945-'7 CY13
C. Retailer's name:
D. Retailer's address:
E. Retailer's certification#: Telephone#:
F. Installer's name: 10 111- zI(.1 C.,,yaf
G. Installer's address: DS,fi✓ ' � `, 1'jk)Y •✓.Yf 41,4-25 51'
H. Installer's certification#: /1--40 .2(7!9/ Telephone#: ,5%7 79 071-73-1
1. Date installed: +1107 II/ Municipality issuing buildin ermit:
nn (City,Town, Village)
J. Customer name and physical address (911)where home is installed: KO3 14/ jz�E✓r"
i ,4t/ _ . . _ . I. .a ,New York.
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 ta,_and not in limitation of or substitution for,any and all other warran-
ties,express or implied,given or made by the Installer,wether contractually or by operation of law.
Printed Name of Person Signing Seal: 4.1Lapec
Signature of Installer or
Limited Installer: st.a's
If you have a problerrrwith 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
YIV T/
Queensbury Building & Code Enforceme — Manufactured I Modular Final Inspection
Office No.(518)761-8256 Arrive: am/pm De art ( \ ipm
Date Inspection re9m. t received: Inspector's Initials:
NAME: 1-6 ��-- PERMIT* ! -023
LOCATION: 6 6 A‘.// ) 1LQ . DATE: A '.Z `\
Manufactured Home
Modular Home
Footings • _Foundation Backfill Framing
Comments:
Yes NEA
Foundation support,pier spacing, 11
Per manufacturer e ��''��'`�
Anchoring per manufacturer 2'from ends
Water line shut off
Sewer line support @ 4 feet 141SIMO tk
.)1Vrre.Arti>
Heating Crossover jdoublewide)off grd. —,:741‘V
� �`
Dryer vented outside 11
Skirting ventilated 1 so.ft.per 1.600 sq.ft.
Hot water relief valve piping outside U ¶2J7,4 .3(, j1)5
Deck,porches,steps,railing
Furnace/hot water operating SetA/et'c"' N
Garage Fire proofing
Fire Door/Door closers
Plumbing Fixture/3'Vent through roof[Modular] CS�s3
Foundation insulation jcf applicable] k7wle'
Smoke/Carbon Monoxide Detectors/Interconnected
Final Electrical ''"��� f)R5 v L J\E
Variance required , _ q �
ktirt 501r,I",
Data Plate okay �s
Manufactured HUD seal okay
W a, .� al after January , v./
Installers Warranty Seal
18'x 24"access or 22'x attic access
Vapor - r i i n'- home 6 mil poly or other
911 Street number
Okay to issue VC or CEO[Temp./Perm.] •
Model# Serial#
CtManufacturer 1
Date of Manufacturer
L:IPam Whiting120101Building Codes FormslManufacbured Modular Fmal Inspection 03 04 10.doc
Queensbury Building & Code Enforcement— Manufactured / Modular Final Inspection
Office No.(518)761-8256 Arrive: am/pm Depart Z r3)am/pm
Date Inspection request ' ed: Inspector's Initials: e).09
NAME: linthtglo Vic, PERMIT*. 11••' c
LOCATION: t 6' ,4Gp//4/C 4V/6". DATE: Zl OA_
Manufactured Home ✓
Modular Home
Footings • Foundation Backfill Framing
Comments:
Yes No WA
Foundation support pier spacing, Z.��ttA. / Ce,k i_ '.
Per manufacturer
Anchoring per manufacturer 2'from ends C) hi$M-e-C- ANG/tp/Q,S /Ai .,/e/006
Water line shut off
Sewer line support r, 4 feetf_i) lj(iPF',,Q f 6o-1>77G I-M
Heating Crossover(doublewide}off grd. /.
Dryer vented outside
Skirting ventilated 1 so.ft.per 1.500 sq.ft. PIiL#iv yot ‹C/RT��
•7 /
Hot water relief valve piping outside � /4I742
� 61c MAID D PP6IX' %6 6)crgie f OR V
Deck,porches,steps,railing ( T/*ov/v6 L,R}N'N/lXP "1-7---4411Z ' '
55
Fumace/hot water operating •
Garage Fire proofing •;:5 . < X5 LS
Are Door/Door closers &to ,t
Plumbing Fixture/3°Vent through roof(Modular] el64 -\- )5"-er) -5
Foundation insulation[if applicable]
Smoke/Carbon Monoxide Detectors/Interconnected 0 J1*'Ql tr2*-b 6#k 0lk6- Per.
Final Electrical 7ick,\k 1 (_----4, 64.:7t,tibilf-,44. -----, eA�
Variance required
Data Plate okay
Manufactured HUD seal okay < --1
Warranty Seal after January 1,2006 � ` SI L l i_k.
Installers Warranty Seal c
18'x 24'access or 22'x 30'attic access
Vapor retarder under home 6 mil poly or other �kAle-
911 Street number i C7.)Al�f.rist !L N .�R r -
/
Okay to issue C/C or Cl(Er,/Perm.] - T
Model# Serial# SAO cri.t -'
Manufacturer
Date of Manufacturer > /trA.X.- ft_
L:1Pam Whiting120101Buitding Codes FormsWlanufactured Modular Final Inspection 03 0410.doc
„ , /O-/ jr)-e\----
Queensbury Building & Code Enforcement-- Manufactured / Modular Final Inspection
Office No.(518)761-8256 Arrive: :0'‘m/pniieej....,,wt: am/ m
---� PDate inspection request received: AtO • his'/ // ins or's Initials:
NAME: PERMIT#: C7 -6,23
Y-(511, ,cteCo-e a �
LOCATION: /, A lq°�-- / DATE: z11 3 ,
/ W 4 4 h 7ce��
Manufactured Home f ' ' �—
Modular HomegeC-. G
Footings . Foundation Backfill Framing 4 Sfixec,3 cr L W
Comments:
Y No _
Foundation support,pier spacing,
Per manufacturer
Anchoring per manufacturer 2'from ends 1104•0,-L.,4__ A rJe-i-t D IQ
//
Water tine shut off
Sewer line support @ 4 feet ,ppn(7 j ) 4.- L /1°67'
Heating Crossover[doublewide}off grd.
/ .
Dryer vented outside
Skirting ventilated 1 sa.ft.per 1.500 so.ft. fR OV 1 V6- \IG'/VEt7
ig7'1/
leio
Hot water relief valve piping outside7
Deck,porches,steps,railing ill 4) -1A-Le.- (PrA,,i cs Amt' '77'C'
Fumace/hot water operating •
VLu
Ffrex'
Garage Fire proofing . ILI:FQ 're? 6)rG/2-
Fire Door/Door closers t OR
Plumbing Fixture/3”Vent through roof[Modular]
Foundation insulation[if applicable]
Smoke/Carbon Monoxide Detectors/Interconnected 0 /ArAi..C., IAAA) (01/26 b IA,411c—
Final Electrical 74,�r"111 06,-( -2 s
Variance required —7,,-,
Data Plate okay
Manufactured HUD seal okay
Warranty Seal after January 1,2006
Installers Warranty Seal
18"x 24"access or 22"x 30"attic access
Vapor retarder under home 6 mil poly or other1
911 Street number /‘171 26 b L,(.It 11t .
Okay to issue CIC or CIO[reernp./Perm.]
Model# GNI 6)(p3)( Serial it V41 Lrof 467045—43— 4 YiS _
Manufacturer 1 b 1 14.)00-0 4i 6-5
Date of Manufacturer 11- o
L:1Pam Whiting120101Building Codes FonnslManufat ured Modular Final Inspection 03 04 10.doc
FINAL INSPECTION REPORT
MOBILE: / MODULAR
Town of Queewry
Building &Code Enforcement
742:Bay Road • •
Queensbury,.•NY 12804
(518) 761-8256
ARRIVE:1 t 4DEPART: ' INS .
DATE INSPECTION REQUEST . . .
NAME: g6f„) „Qt.! ' ._
LOCATION- L! Aco _ �
DATE: I I f! PERN[fI' °
MOBILE HOME MODUI:AR.HOME
FOOTINGS+ FOUNDATION _.BACKFILL FRAMING'
• N/A. . YES NO
L foundation support, pier spacing • .
Per manuf•
2. anchoring per i anuf. •
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. furnacelhot 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# (ei Serial#Ve)-I(14 J
Manufacturer Fo '*D
Date of Manufacturer 1401,01
• /
. OKAY TO YES, ”:NO
, io
tot PLCL n "56446 r
573
A
TOWN )F ' -e%
BOLD G cop
� Review -d r -��
V °ate i v "
ILE COPY
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Bas d on our limited examination,compliance
with )ur comments shall not be construed as
inns are in
0:1 Edi comp)ancthe e withans the ldingmCodes of
New cork State.
it
O i
1(r LLOZ G ij I'•.��.�%� I,
CL
•
0
2
flOT10E •
ANCHORING OF MOBILE HOME
4 aa)
FRAME IS REQUIRED PER o
MANUFACTURERS SPECIFICATIONS
c c
ca o
Qct
Q
Q J
/ x�
yew.
Road Name:/L I p! iu.. R Ue
-.
,
t.1' --- . •''. i,'",,,,
i6 '
ti My 2 -I 2011 i II
I i 1
-
, t
r Buff D i, s_i . —ivs6uRy
1*---
...„, 6--- 7 1
1 tei ,
CI
I
4 .
1
. ....1
fil•-
I 1.-4. 11.1 E /c( ,
1
. I 1 V. 1NG ii 04. At\ . •
;
,
.
if I
.....-7--
..., § f °
...,1 . .
. .
..e.
a. _=._......
,, .....
.
.
. .
. 6 1......)
.....,,___ .
j • : i if «. .~3 f . J/-!� ? 20' IT) ;
/3-lerrikA"'
�'( 1 71/_~u1 i t ,t V.. ......_.` .1 Lel' .�
4 -1e
j , _ ti lis,, 112
1
Pi
-rit' 94wi'-' ,,
1 . .
, .... }
) 2- peitipe.p
40
it
6 lb Jr.
i
y b1 1
P1
9
N-1
i r.:1
if ,
Il'4.
} !
1 ir
.,t, z
t
1
I c
1-'
ri
f 0 ,�
i