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2010-440 TOWN OF QUEENSBURY two742 Bay Road, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20100440 Date Issued: Friday, August 24, 2012 This is to certify that work requested to be done as shown by Permit Number P20100440 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 /&/3 am (trS+ 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 Planning Board Director of Building&Code Enforcement or Zoning Board of Appeals. TOWN OF QUEENSBURY f410111a 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMI Permit Number: P20100440 Application Nun4 r: A20100440 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 p . s d other info . :on hereto filed and approved and in compliance with the NYS Uniform Building Co);... • the Queensb ' oning Ordinance. Type o Constructio Value Owner Address: HOMESTEAD VILLAGE L P 4294 ROUTE 5 Mobile ome In P ' $36,000.00 CALEDONIA,NY 14423 Total V ue $36,000.00 r Contractor o :uilde 's Name/Address Electrica) spection Agency w Plans&Specific. ions `. 2010-440 143 Elmhurst-Andr-: I eene- 8'0 sq ftobile home in park $25.40 PERMIT FEE P• D-THIS PERMIT EXPIRES: Friday, September 07,2012 (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 To ueensb , s. y, September 07,2010 0 SIGNED BY /Ci 1 for the Town of Queensbury. Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 EtT Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20100440 Application Number. A20100440 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 $36,000.00 CALEDONIA,NY 14423 Total Value $36,000.00 Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2010-440 143 Elmhurst- Andrea Greene- 840 sq ft mobile home in park $25.40 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, September 07, 2011 (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 of ee ;a�1 ay, September 07,2010 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement i �j�^,�' 772- (/ OFFICE USEO Y 'rte��o ! ,� /(,)-4-"HL) , TAX MAP Not,. PERMIT NO. DATE ISSUED: PERMIT FE C APPROVALS: ZONING TOWN CLERK - --\ -0,::407 i ' /IAA 4A_L SSI/490V, e/c .1\:f So-V11 4--- , MOBILE HOME— APPLICA TION 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 Name: �^ `1CittA �'"a'�B'l c- Name: Kon �t ad /610 LI) iC 4)) eV Address: (r3 2 fkasciiit Vat CCAddress: ',al AI !� a , y( O. � 0 , IL 74 Y. 1 c9 fan, I- . Phone No. 5/ 2<-- 6- 3 S - /0 6 S _ Phone No. 5i, - ),?-(a- ?c ? Parcel Information J Proposed Date of Placement: Property Location: q 3 jrn )- 4-v3� Road,Street,Avenue Name of Mobile Home Park: NOrYleS-rz (if applicable) Tax Map Number: Mobile Home Information Zoning Information Approximate Value of Home: $ 360 00 Zoning Classification: New Home: Yes No01(‘' ,N .! Size of Property: ft. by ft. 6 Replacement Home: Yes No l r,/ Existing buildings: Size of Mobile Home: 6--- by /1/ ft. Setbacks: front yard ft. rear yard ft. / side yards ft. and ft. Singlewide: t/ Doublewide: � rt- - - Number of Rooms: (exclude baths) ,3 // Accessory Building(s): circle Number of Bedrooms: Number of Bathrooms: / 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 Water Supply: well or municipal Runners Slab Is Septic Permit Required? Yes or No Continued on page 2 ` Town of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804 Revised March 2010 Name of Installer or Mobile Home Dealer: 1d -PC�I Address: &33 (rxiSarit Vo /e ' Phone: ,3-1: --6,3?-1c7„--k Complete information below found on a "Plate" or/"Sticker" which is affixed to the mobile home: ✓ Insignia serial number: 1_--R —00037`7 dot /�5 ✓ Name of manufacturer: ✓ Plan Approval Number: ✓ Model or Component Designation: (New home only) ✓ Date of Manufacture: AFFIDAVIT i •: Town of Queensbury State of New York • County of Warren i •; i 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. r Installer Warranty will be provided" t time of Certifi ate of Occupancy. Signature: 6../h.elt.e.,4 • Owner, Owner's Agent, Architect, Contractor SPECIAL CONDITIONS OF PERMIT f C•'.e ' nforcem-nt • c-r Town of Queensbury• Community Developmen •ffice • 742 Bay Rol, Queensbury, NY 12804 /OA_ Queensbury Building & Code Enforcement— Manufactured / Modular Final Inspection r i Office No.(518)761-8256 ' ff Z Arrive: am/pm Depart CC/ am/pm Date Inspection request received: Inspector's Initials: NAME: /.1 5 V - PERMIT `f LOCATION: I �-� r ( ( u i 4 ( DATE: S/ZZ j2 Manufactured Home l tt Modular Home Footings Foundation_ Backfill_ Framing_ Comments: Yes No WA Foundation support,pier spacing, Per manufacturer Anchoring per manufacturer 2'from ends Water tine shut off Sewer line support @ 4 feet Heating Crossover(doublewide)off grd. Dryer vented outside Skirting ventilated 1 so.ft.oer 1.500 so.ft. Hot water relief valve piping outside Deck,porches,steps,railing Fumace/hot water operating Garage Fire proofing Fire Door/Door losers Plumbing Fixture/3"Vent through roof(Modular] Foundation insulation[if applicable] Smoke I Carbon Monoxide Detectors t Interconnected Final Electrical Variance required Data Plate okay Manufactured HUD seal okay Warranty Seal after January 1,2006 '�L Installers Warranty Seal 4F-C2vC;4 � 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./Penn.] Model# Serial# Manufacturer Date of Manufacturer L:1Pam Whiting120101Building Codes FomusManufactured Modular Final Inspection 03 04 10.doc `_ j{ _/ ' %,i'r. l -- `�/ - ,_ Queensbury Building & Code Enforcement— Mahufactured I Modular Final Inspection Office No. (518)761-8256 Arrive: 2,..4t t v a p i pm ^: am/pm Date Inspection request received: Inspector's Initials: FMK NAME: /1/1‘ --'�. Zl/''1 2 -' _ PERM #: /�, Y (� LOCATION: /� 3 i/�_/1 3r- DATE: Z-— I 0-1 I Manufactured Home Modular Home Footings_ Foundation_ Backfill_ Framing_ Comments: ym No WA Foundation support,pier spacing, Per manufacturer �-}L;i0/re f 7-2---ti 'y. Anchoring per manufacturer 2'from ends Water line shut off Sewer line support @ 4 feet Heating Crossover[doublewide}off grd. Dryer vented outside Skirting ventilated 1 sa.ft.oer 1.500 so.ft. Hot water relief valve piping outside Deck,porches,steps,railing / Fumace/hot water operating / Garage Fire proofing ���/// . Fire Door/Door losers 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 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 C/C or C/O[Temp./Perm.] Model# Serial# Manufacturer Date of Manufacturer L:IPam Whiting120101Building Codes Fomes\Manufactured Modular Final Inspection 03 04 10.doc i-..) end ueensbury Building & Code Enforcement— Manufactured / Modl inal Inspection Office No.(518)761-8256 Arrive: 1%li a el,:t: a• 'pm Date Inspection req e . received:✓ Inspector's Initials: ! • NAME: ��/?€fl PERMIT#:f /– LOCATION: xEy,„-c571- bf. DATE: / /7-76 ) Manufactured Home Modular Home Footings_ Foundation_ Backfill_ Framing_ Comments: Yes No WA Foundation support,pier spacing, / Per manufacturer �// Anchoring per manufacturer 2'from ends — ��tFj� �VS�F �� Water line shut off 5'�E Sewer line support©4 feet � `' vl G v' "F""r t c3 Heating Crossover[doublewide}off grd. / 4C3 ��� �j ‘Q�3 s Dryer vented outside i Skirting ventilated 1 sa.ft.per 1.500 sa.ft. �R �p�j� �v � ��L Hot water relief valve piping outside Deck porches,steps,railing V-Vi2:N 1 rj' 11t-- 0 Fu operating ,r .4 p-,--,,_ , ‘ „,___ Garage Fire proofing Fire Door/Door losers -- ��-1� Plumbing Fixture/3"Vent through roof[Modular] Foundation insulation[if applicable] J –Ice CD, \Z-'0 .5-4?---V -/Vw 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 f 18"x 24"access or 22"x 30"attic access Vapor retarder under home 6 mil poly or other I 911 Street number Okay to issue C/C or C/O[Temp./Penn.] Model# Serial# Manufacturer Date of Manufacturer L:1Pam Whiting120101Building Codes Forms\Manufactured Modular Final Inspection 03 04 10.doc FINAL INSPECTION REPORT MOBILE / MODULAR j f Town of Queensbury e-`'Y v Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 / (518) 761-8256 ARRIVE:i'3bDEPART: q INSP: --4 fir DATE INSPECTION REQUEST RECE v NAME: it . 7V _ s --�= - LOCATION: 't-e ,, SN. ._ '-~ IIIPP Ili DATE: S. PERMIT# - Ir 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 — _ — kDE i •. y Model # 0:01.4. :,,a.7. Serial# -e----( j`l 1-f Manufacturer E&E ? /E -% Date of Manufacturer �-- 1t'-� OKAY T YES NO Comments: %����y�, tel, • ,.....,- ___i_ 1 (4._;) „---- ir),--, i-vA7St ,S-k..4•1:_,-,: 1 1„ -)hserved, or believe I saw evl' fall r ,l'ArArNI, , ,,e,s, wells trees tP 1° u: ( 11, )tay i al e ill . .-_, ,__. _ . ! 1 1 1 1 r\ iXek, M HOME , , I / ovz ANCHORINNGOOTF IC0BEILE 1 . \ FRAME IS REQUIRED PER / MANUFACTURERS SPECIFICAT!ONS '12. c... 4 TOWN OF QUEENSBURY BUILDING DEPARTMENT Based on our limited examination,compliance 1 with our comments shall not be construed as indicating the plans and specifications are in full compliance with the Building codes of ( k) '1'; New York State. —1 li .) A --"-: 'g. i ,- Go rKer __ -%--, Lor 143 EL4pArst-biriv-c- t)-(2'1' I • . 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