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2012-238 TOWN OF QUEENSBURY 13" 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20120238 Date Issued: Tuesday, March 19, 2013 This is to certify that work requested to be done as shown by Permit Number P20120238 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 1 0 3 ''I p i A e jV 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 .441% 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20120238 Application Number: A20120238 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 2012-238 New Mobile Home 103 Alpine Ave. CMH Manufacturing 14x66 single wide $110.88 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, May 14, 2013 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town of sbury; Mon s a,,, ay 14, 2012 SIGNED BY for the Town of Queensbury. Director of Building& Cod nfo` - , ent II OFFICE USE ONLY 0• g -4-0)--- TAX MAP NO.3 Oq' .`4-ARMIT NO. I a - d 3 S' DATE ISSUED: i a I' PERMIT FEE t/ O "- APPROVALS: ZONING TOWN CLERK � Stamp i J UUILDjNG ii, CUUEJ MOBILE HOME -APPLICATION FOR PERMIT: A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a valid building permit has been issued. Applicant Information Property Owner Information Name: // s k Vi life, Name: 46/ /47,776--.5 Address: 20( /1.22ec/z.e E_el Address: f/,SUS ,.-71 t5 vee/1.5&un./ I �y /2 / ( 4164i4 �i'' /4/9'0Z3 Phone No.(57, ) 3O3 -,s--; // Phone No.(S8g)Z? -�/S-O Parcel Information rx f `3' ' Proposed Date of Placement: .5 ,�// Property Location: 4�//Z-e 44/6. JJ �� Road,Street,Avenue Name of Mobile Home Park: /?ZS4gd/ /i -(ifapplicable) Tax Map Number: Mobile Home Information Zoning Information fr Approximate Value of Home:$ 34000 Zoning Classification: New Home: ©Yes 0 No Size of Property: 43 ft.by /,2 ft. Replacement Home: ®Yes WI No Existing buildings: /VOA/4f- Size of Mobile Home: /3/ f. by 66 ft. Setbacks: front yard 016 ft. rear yard /$---ft. side yards AO ft.and l ft. Singlewide: ' Doublewide: Number of Rooms:(excluc baths) 7 Accessory Building(s): Number of Bedrooms: ...i Number of Bathrooms:7V. Detached garage:01-car 0 2-car 0 car D Gas Fireplace 0 Woodstove 0 Wood Fireplace Attached garage: 01-car 02-car 0 car Foundation Support: Storage building: 0Yes E!No Type Size & Depth Other: Piers Runners Water Supply: ['Well Municipal Slab Is Septic Permit Required? Ill Yes L"J No Continued on page 2 f: 'c: 't 5 .`4Tozvn of Queensbury• Community Development Office • 742 Bay Road, Queensvury, iv r tlrsua r. 12 02: 28r Homestead 5187022400 p. 3 Name of InstalterorMobile Home Dealer. AEC . 4 • .r Address �,?D (d/ d�/1M/,4von Phone: 5 - 22/ ••Z/6O �7 . ei C'let 61clt1t-ua., Ivy /crcv�3 Complete infotmalion below found on a'Plate or`55'dcer which is affixed to the mobile home: ✓ Insignia serial number. I Name of Manufacturer: �,U i , / (l/7/r'C7 e-te,f ✓l9Ce, ✓ Plan Approval Number: ✓ Model or Component Designation: 5-6.ZiVS7 t/( 3 A N/a2 (New home only) ✓ Date of Manu e: 526 4;2 /0e 6 6 S/i a-we i(1137K' SCrerAl r' -�<,. �•.� `� fitly p/iii /)rate i AFFIDAVIT AfO< A'/tiled Town oft tsbury State of New York 02-h/ /yt t1ni-B1c4County of Warren '} �"E^� 1Qt1/ s • l4// haw act 1�ATA- ; . i swear that to the best of my knowledge and Wel the . et c 12el& t -4 statements contained In this appkaton,togethor war-the plans .and spec#tc ations submitted,area true-and-coraplete statement • of a proposed work to be eons On the desrxr'bed.premises and that all-ptovfsions of the:BUILDING CODE,the ZONING ' ORDINANCE,and all other Maws pig tote pnaposed work Sha be fed with,veer Specified-or not,and that such s wort(is authorized by the owner. 3 Signature_ .& % ‘cr.'OHM;ft�• • s Agent,Milted.Contractor • 5 • SPECIAL CO.NDTFIONS OF PERMIT 4 . i �y < • .. Code-:. . .:• - t Officer - �N NY1� O . - �`-�= 1`Tarort Of Qtfeensincrrf*.Cammrmity Deva'�rprtr�errt Comae•742.i3mj Road,QueensFiurJ-tr j jG[J{r�. - 7 ._/(:), Queensbury Building & Code Enforcement— Manufactured / Modular Final Inspection Office No. (518)761-8256 Arrive: am/pm D rt: Iarn/pm Date Inspection request received: rr Inspector's initials: l 1 NAME: `-Y\-t) Val-- PERMIT#. 7 1 C- "Z-3 LOCATION: I c 4/S/Nl ✓l-V'L.= DATE: 2) I I '3 ( ( —3 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[doublewide}off grd. Dryer vented outside Skirting ventilated 1 so.ft.per 1,500 so.ft. Hot water relief valve piping outside Deck,porches,steps,railing Fumace/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 0// 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 CIO[Temp.I Perm.] ::::cturer Serial# v �. Dateof Manufacturer ------- L:1Pam Whiting120101Building Codes Forms\Manufactured_Modular Final Inspection_03 04 10.doc INSTALL NO. 19009 STATE OF NEW YORK DEPARTMENT OF STATE fit ONE COMMERCE PLAZA �^. 99 WASHINGTON AVENUE ALBANY,NY 12231 INSTALLER'S WARRANTY SEAL THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE ® NEW MANUFACTURED(HUD CODE) ❑ RELOCATED MANUFACTURED(HUD CODE) A. Manufacturer's name: 4�: �B. HUD label number: N f-ii )C o Serial number . r_ __ I 1 ! C. Retailer's name: 1=tCt D. Retailer's address: r' - -1='!= — b _ :;f • i E. Retailer's Retailer's certification#: _U t r� ' <% 1 " ; 5 - - ------Telephone#: " .:-- F. Installer's name: 1-'• • i. i" ••01 i G Installer's address: `; ' - t� _ • . _ ' _-- ! i Li -H. Installer's certification#: J- 't'1 ` T. =! '_� ' Telephone#: = .y =._ ::3 I. Date installed: - t '• G( - Municipality issuing building permit: �+ • •r. , (City,Town, Village) J. Customer name and physical address (911)where home is installed: • . . _ i 51, „) \I,I l , ,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 to,and not in limitation of or substitution for,any and all other wanan- ties,express or implied,given or made b t Installer,whether contractually or by operation of law. Printed Name of Person Signing Seal-, 63-``4e. — 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 FOR MDIA USE ONLY FOR MDIA USE ONLY MIDDLE DEPARTMENT INSPECTION AGENCY, INC. APPLICANT COMPLETES THIS SECTION Date: City,Town or Township County State Location/Address • • (If Located in Rural Area-Please Attach Directions) Pole# OwnerPhone# Permit# Occupied As Building: New n Old n Occupant Work Area in Building (Floor #, etc.): App.for:Wiring I I Service or: Ready for Inspection: Fee Remitted -$ Cash I I Check' I M.O. I I Make Payable To: M.D.I.A. Number of Rough WiringOutlets 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 9 Elect. Heat Switches Amp. Service Surface Unit Dishwasher Range Lighting Water Heater Air Conditioner Dryer Pump Receptacles Oven Garbage Disposal Wiring and Controls for Burner Number of Fixtures Amp. Receptacles Fractional H.P. Vent Fans Other Equipment: MOTORS H.P. 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1'/ 2 3 5 7'I 10 15 20 25 30 40 50 75 100 Mark Number of Each Size Applicant has read and agrees to terms and conditions on reverse side. Applicant's Signature License# Permit# _ — T/A Utility: Applicant's Address: (NAME) (OFFICE LOCATION) (City) (State) (Zip) . • Service Request# Phone# Electrician: MDIA USE ONLY DATE RECEIVED: DATE INSPECTED: Correct Location: Same as Above n or: Red Notice Label I Rough Wiring Outlets Surface Unit Oven Switches Range Garbage Disposal Receptacles Water Heater Dishwasher Fixtures Air Conditioner Dryer Amp. Service Equipment Burner, Wiring&Controls for Amp. Receptacle Amp. Service Conductors Pump Vent Fans MOTOR H.P. 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1'12 2 3 5 7'12 10 15 20 25 30 40 50 75 100 Mark Number of Each Size 500 750 100D 1250 1500 1750 2000 2250 2500 2750 3000 Elect. Heat CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECTFEE FEE PAID I RW Progress: Inc.I I LKD n Contractor u/ l 1 CFT Violation: Work Comp. I I Inc. I I _ _ CASH I L/A Owner Fee CHK# [ I L/A Due' MO# I I IPA Municipal INV# Date: Other Sidefl Utility Applicant I 1Owner Cut in Card I I Temp# Date I IFinal# Date INSPECTORS SIGNATURE APPLICATION FORM NO.250 EL 6/98 ©Copyright 1996 APPLICANT'S COPY IJ :j t ____3 Queensbury Building & Code Enforcement — Manufactured / Modular Final Inspection Office No. (518)761-8256 Arrive: am/pm Depart:2, _-) am/pm Date Inspection request received: ._? -/3-ii 3 Inspector's Initials:(1,UX) NAME: ?)m er4ece d PERMIT#: I ----13 7 LOCATION: / 03 A I pi.') -e, I ► Je. DATE: 3 -I3 -/ Manufactured Home PC Modular Home Footings_ Foundation_ Backfill_ Framing_ Comments: Yes No WA Foundation support,pier spacing, //0 Per manufacturer Anchoring per manufacturer 2'from ends `/ Water line shut off Sewer line support @ 4 feet / Heating Crossover[doublewide}off grd. / Dryer vented outside .� VV-12-127V -:- n _ Skirting ventilated 1 sa.ft.per 1,500 sq.ft. / �`�' Hot water relief valve piping outside \V/7,., /// Deck, porches,steps,railing V 1 l/ �`�i5 S' 21/VL-,- Fumacelhot water operating ` / Garage Fire proofing "�� • 4 Fire Door/Door closers V Plumbing Fixture/3"Vent through roof[Modular] Foundation insulation[rf applicable] \s/V Smoke/Carbon Monoxide Detectors/Interconnected Final Electrical .41.. / Variance required Data Plate okay Manufactured HUD seal okay f 0 Warranty Seal after January 1,2006 V Installers Warranty Seal II 1.7 18"x 24"access or 22"x 30"attic access Vapor retarder under home 6 mil poly or other 911 Street number ✓ o ' Okay to issue C/C orCIO[Temp_/Perm.] Model#-7Jic' C.4., Serial#f.., v✓cIc(ol3fiF Manufacturer ! " `l-'ZS-h`� � Date of Manufacturer --Cl I 4 1 2--- L AP a m L1Pam Whiting120101Building Codes Forms\Manufactured_Modular Final Inspection 03 04 10.doc MI of c • � o /� 58' -5 I/1' m �Z :l.l - ter. 55' -1 3/d' Z !t I �.1. .,,w. t,.zo WATER LLj I! u,' ` t tv 5T' -i' 28' -G' 19' 8'W , 0' ILLIa�c' �- iz B 3/1' I \ u Z v0.1 n5- i1' -0. L • I - �� i4' 2 r -r— Cfal — I 1- � iiwiiU Y'; 5 -0' 17' S~ m I ', — �` ^� — t � 1 O ELECT /'I 0 • I 0 �`// `` ►► 1 1 ' 9- Dm`J DROP T22. -I S/B' ...... a 25' 5/8' >� cc -0• 0 C 0 1.- PIER PIER LCCE.V _ Q) SERvlct E.T5M4 LCCZ'u —> ■•y/•al al wr;K C0./M _[LEMMAS JbP `ryED-SEOM •,atK M.,Q•M1R I&C1 •` REAS El•Dry,,.. 4 OaOP 0.........,wEa MIK CROAK "--. ©-CRS IN.CT PS ®-......•..oeo.•.cccsae ar•• L 0 y....,REKf w,1„1•Ks.. R.I.0.L oanas PCR rwaon nrt SHOWN WITH 1/2 BATH OPTION �,; U ... RAl9'.Q ENTIVRIw NO A.n.cr pP• a(,1 .NENOPTICR S7 r71C•. --- ' 't�•S�Maar�lwS•/DII.R to,illi 1 i '4MI NL9N 7S•'Gi N P.SA.AP.K.pr OCR=MO .S0.0 i SO.N.S POR KONG Q.s.r•0•,ar CROSS P-Kw.Mr(X.r LL K PK4'Kt.trt,,.p rI (P ,Ma KIN=MOM.O(9.0. s Km P. a 37 sa.1•.0M.JL AN PUNK NINA.7 rt.K DO,GMP iy SO.N.KM4A71 N AMID AMIN •0 MK MRitLETT[ RUES LHI t R E v I s 10.s H p11C c C M c a n L ,I 0 I(s --- RINPG mu P F /y. KA U( INS'1RRi ION w.PS. 0. roo,lw$SK *to r6CDP.Son WORK PKin a0 PIP t70s 1 7-.{7 VCT Kn.t xSOsnsa KA K. cat,0 ROMANIAN,MAI PO NOM rOp1l SINK (� L 1 LC CMH MANUFACTURING, INC. 99 1 l2 SEAM SPAC 1 N 956 1+x66 38R-18R 956H]01+-66 balm r. a c.salt alt 7vlrltc yctl w. RLU 0+/2+/2012 01/26/2012 21-P5-99 0 Co Q) 1- 0 U- 0 a- ... 1 r .. r. • i/dei r,. 1 11 .it 1060) • __ . kv .Jul iiil,uumrriiwiiiii • �s • •.� �' �r Illi , SIMIIIIr.:�NE ; BEDROOM 2 .n �i. • MASTER BEDROOM `�: �I: amnia'''. „ UV 00M T-9^X i5-9^ .�1� 1Q'ER x 1 • p1” 11 13.0+` ,.q- y BEDitOOM 3 �� �f'!ii 8•-Q^X 12•_4.. 1 , AR:4111rilla sz---Tii • 1. .... .. `. (-----7 .. 4.: ..„ , . L..R.•i!^ti,,,.•..„.:,:•:,mow W-6:,, s•t‘. 4,, 91( 46:40. 'Pe WO) 1)3 . LI I i)„ j Ce.:(//i< -Al .-.\\''.1.../ �-' � I '\k-0.1'041°11.(/./: • NS?'IRATION O tll+1�(� ALDER ' ` y V J P Maj 07 12 02: 28r Homestead 5187::22400 p. 3 Name of Installer or Mobile Nome Dealer. ,46L i Address 4 ? Cd. ee-lii ? /Wort a Phone: .56)C-- ?2l• - -Z/5 ) T 3jU aCedeklua_� lily /0/(123 Complete information below found on a"Plate'or`Sticker"which Is armed to the mobile home: ✓ Insignia serial number ✓ Name of Manufacturer: C,1//1"/ /{/7JI(gra C iUN7, ✓ Plan Approval Number: _ ✓ Model or Component Designation: 5-6_2-46/r{ .3 A-14 47 (New home only) • Date of Manufacture: ,51-704,;? _ �ScziAt ' i'i ITIDAPZT 400 p/an appamP i Nor AST/644-e/ Town of Queensbury State of New York I )-/-/ /?'I at)vieleAd County of Warren `l . , )a1-av (,t1/// /�IN/P at) QAT 5s I swear that to the best of my Icnowfedge and belief the ptIpr 4r Aelok -g statements contained in this application,together with the plans • and specifications submitted,area true and complete statement y 's•of all proposed work to be done on the described premises arid 1 that all provisions of the BUILDING CODE,the ZONING $ ORDINANCE,and all other laws pertaining tothe preposed worts shall be complied with,whether specified or not,and that such 5 •work is authorized by the owner. r Signature:_ CCI a-7 5 Onager, s Agent,Amiltect.Contractor � 5 SPECIAL CO.NDTFIONS OF PERMIT Eiy: . : . 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'4,1A) r,i—t• 1,4:1 .I.,.(21 c 4 :'i••-;I-; ,cirf .5,..)4- CI F-4• C--I L--- .c•-• c--- NI- 1---.1 co , ' ''', 1: . t ' it 1 i • 1 :* 1 . ,. , .,i'cl* • :s-i -(' r-i •f-i • v-I , I 7 ' 1 11 1 ,r) • • .1 _ ____. "7- 1,0.1 c•4• .t-i• 0 0— rtirC" j .....7-•i' ./ % ' .E_ SLic•r-C)R. NE , i .., . 1 I . 1, ,,, . , . • 1\ t ij . t.' E .. 1 iSt) r.t LAAST t)ft‘v E • , •-.... . • .• , EL • . 4 1 ' 1 7-Z 1‘ I .. / 1 l •I. '. t • 0 , r-i , cN ..f-r) 'cr., tn . -s: ic-) .)00 i cr 6.1 vi 1 '-' —1' ' -°-1 , • ---- ------------ -- - -- • • . , . . - • WE sbr C.)9A%1E .... • . ,, .. • . . • . E--. /cR6 - I ... . ,...._________,,____:: ..p • 3 \ I 31-- alit, •. . ,. /\\ 11 - IIIII.r J • ('N r\ . ......r I' :_.•...,./7'4<"---- ---- ., c--, -4— ---k_-bit (-(--\ iq. t : (,-._.. , , , , . . s , i. 4 \ ---) ' �) i . \ Fi-L-)/17(-' cQo 57( I--- -- / //_..5' ---)'7,77.7)-7& .5.1 oC to Applicant: / �r l� �j l Location: / P& (SY Homestead Mobile Home Park },, ,, ,; ? ;„• ,} ao ;.na ,, : ,,, tl I„