2013-087 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: P20130087 Date Issued: Monday, September 23, 2013
This is to certify that work requested to be done as shown by Permit Number P20130087
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
S f p1,1So A N TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property
of the responsibility for compliance with Site Plan, Variance, or
P t3' P {ilk--
owner
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
A 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
f��
a Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130087 Application Number: A20130087
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
CALEDONIA,NY 14423 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2013-087 95 ALPINE AVE.
Mobile Home 924 sq ft Giles Industries OMG Model 14663A
$110.88 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,March 12,2014
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of uee my; oueS , , yarch 12,2013
Ar
SIGNED BY Il for the Town of Queensbury.
Director of Building&Code Enforcement
C
`. OFFICE USE ONLYi
, TAX MAP NO.J O CO- ER'MIT NO. 1 3-0,0 DATE ISSUED:
y
PERMIT FFF /JD &S APPROVALS: ZONING TOWN CLERK MAR oiZ §t
p
P
MOBILE HOME -APPLICATION FOR PE
A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a
valid building permit has been issued.
Applicant Information Property Owner Information
Name: t- cfY e S\-C_AcA V i. I I Name: A (_-_( L 1(Yle 5
Address: ,)f)C A,vz,'ne 12,-1 Address: L.:05- 2+ 6 04 l±c cn IA
C70.).6.-211 s6(..))-y/ //). ,2 /Z : -`7)A l L/L/I 9
Phone No.(56--) • •S- 57-2/J Phone No. (58s ) 227 - kIo 0
Parcel Information nn ``
Proposed Date of Placement: 3/.25/ 4
3 Property Location: 95 , l piii A v`e-
ff 11 Road, treet,Avenue
Name of Mobile Home Park: t"l"�A1k0.5 . Vi{t J Aft-- (if applicable) Tax Map Number. .3(242 q 2'
Mobile Home Information Zoning Information
Approximate Value of Home:$ `3L:i Zoning Classification:
New Home: 0 Yes n No Size of Property: .3": ft.by /40 ft.
Replacement Home: 0Yes ONo Existing buildings: /VC/VG
Size of Mobile Home: 1y ft. by 6 ft. Setbacks: front yard 07C ft. rear yard /3 ft.
side yards /0 ft.and <4O ft.
Singlewide: i< Doublewide: C6 0...='
L-v A
Number of Rooms:(exclude baths) l; Accessory Building(s):
Number of Bedrooms: ,1
Number of Bathrooms: Detached garage:01-car ri 2-car n car
0 Gas Fireplace DWoodstove 0 Wood Fireplace Attached garage: 01-car 02-car n car
Foundation Support: Storage building: nYes 0 No
Type Size & Depth Other
Piers '
Runners Water Supply: n Well LNMunicipal
Slab Is Septic Permit Required? ❑Yes 17/No
Continued on page 2
:re_
,Town of Queensbury a Conzmunihj Development Office - 742 Bay Road, Queensvury, N r l,z6114
03/.07/2013 17:03 5852266059 AGL SERVICE PAGE 02/02
Mar 0713 03:19p Homestead Village 5187922400 p.2
Name of Installer or Mobite Horne Dealer: PICA L tAdoles —
Address: 1•MOS RA. 5 t Cateobn 14( -- Phone: 5%` - ab - Cot 30
Complete information below found on a"Plate or'Sticloer"which is affixed to the mobile home:
/ Insignia serial number
✓ Name of manufacturer. 0 i l.0
✓ Plan Approval Number: —
•' Model or Component Designation:_.. 0 M( I Li 4'(0 3 A
(New home only)
✓ Date of Manufacture:
py.w h�vMANM}1ti
�IsK/ N� •ns/nli'sei.nr l,Fn/1.M1M
.nAYn YV wV
ftSl/ �Cf/nrv1 us•srvsrro-o•1JMT1
rt1\�
) AFFIDAVIT 3
Town of Queensbury State of New York
County of Warren '
r
Lf 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
thatali provisions of the BUILDING CODE,.the ZONING ;
ORDINANCE, and all other laws pertaining to the proposed work r
shall be complied with, whether specified or not, and that such
work is authorized by the owner. 5
y
Signature: • • ..t. r
I • .Owner's • • t, • ?tact,Contractor
s
:.Y�Iuscwcw�MrrolrinM1f7�+.�N+Mwr�tXNietlibWi+nhJ/T:.i4�/MNbbM1Yv6Ni�.�Ir 4b/MErIMINiJ�N
SERC 4 L CQNDfflQNS OF PEERMIT
By:
. Code Enforcement Officer
c r`=-'' ':Town of Queensbury- Community Developrnent O - 74Z Bay Road,Queensbury, NY 12801 '
rt _,,,,
Queensbury Building & Code Enforcement— Manufactured I Modular Final' Inspection
Office No. (518)761-8256 q/Oh
Arrive: am/pm D rt:12C2., am/pm
Date Inspection request received: ( ��! ` Inspector's Initials:
NAME: l`10^1 e S ttel 6 lJ 1 l i iL15_Q- PERMIT#: / -Z— U 7
LOCATION: q p I V\ r",t, 1*L 1i., DATE: C7/ 7// 3
Manufactured Home
Modular Home
Footings_ Foundation_ Backfill— Framing
Comments:
Yew,. No N/A
Foundation support,pier spacing,
\i,Per manufacturer
Anchoring per manufacturer 2'from ends /
Water line shut off V/
Sewer line support @ 4 feet y
Heating Crossover[doublewide}off grd.
Dryer vented outside
Skirting ventilated 1 so.ft.per 1,500 sq.ft. v7;
Hot water relief valve piping outside V
Deck,porches,steps, railing f
Furnace/hot water operating
Garage Fire proofing .
Fire Door/Door closers
Plumbing Fixture 13"Vent through roof[Modular] f
Foundation insulation[if applicable] V
Smoke/Carbon Monoxide Detectors/Interconnected
Final Electrical !7
Variance required ✓
Data Plate okay If e-lv7 1",,r �` -1'13N 17•Z 2-)7
Manufactured HUD seal okay l./.'
Warranty Seal after January 1,2006 f
Installers Warranty Seal 1/'
18"x 24"access or 22"x 30"attic access V
Vapor retarder under home 6 mil poly or other
911 Street number ✓
e...4Okay to issue C/C or CIO[Temp./Perm.]
Model#436,0 V. erial# G�r" (el-3PC. 1'
00
Manufacturer
c).--)- -172- ,9
Date of Manufacturer >V'\ 1Th
L:\Pam Whiting\2010\Building Codes Forms\Manufactured_Modular Final Inspection_03 04 10.doc
•
INSTALL-NO. 19840 STATE OF NEW YORK
DEPARTMENT OF STATE
�� ONE COMMERCE PLAZ4
pBr, 99 WASHINGTON AVENUE J
ALBANY,NY 12231
INSTALLER'S WARRANTY SEAL
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE
0 NEW MANUFACTURED(HUD CODE) ❑ RELOCATED MANUFACTURED(HUD CODE)
k Manufacturer's name: ; I 1 l c N r U 57/2 r C S
B. HUD label number. J E Serial number: GT "i 3 tlr't y 7 N
C. Retailer's name: A6-TL 1-1 o 117
D. Retailer's address: L/2 0 K • 5 , 626 /\// /it y
E. Retailer's certification#: 1 1L 57O,z 5 te L 00 I
Telephone#: " ' '=
F. Installer's name: /I lid_ 000/i'''S
G. Installer's address: `"i.3' F,)r r 1: d / 1/ /u y_'
H. Installer's certification#: /1\-1-1, 0 Li L L' Telephone#: ; ' - / 3
I. Date installed: I((,,/ -AO/3 Municipality issuing building permit: -.i v: < ;r5 k) fr
(City,Town, Village)
J. Customer name and physical address (911)where home is installed: /1 I k/5i h ct H,_;(
1 �i' ,' • ,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 warran-
ties,express or implied,given or made by the Installer,whether contractually or by operation of law.
Printed Name of Person Signing Seal: -
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
Wèritage
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IlLi .._ _ Model 14663
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GILES 3 Bed/2 Bath
14'x 66'-880 sq.ft.
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Roxbury Estates MHC
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mm 886 U.S. Route 11, Lot 41
'✓ -. - Central Square, NY 13036
TOWN OF QUEENSBURY .
BUILDING & COPES . PT. NOTICE ran r COpy
B ; �� ANCHORING OF MORE NOME ;'" ; _
Date:we FRAME IS REQUIRED PM
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*Previous model photos. Actual home interior colors/decor may dimer.
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as Manchester Home Center
indicating the plans and specifications are in
full compliance with the Building Codes of 3180 State Route 96
New York State.
Clifton Springs, NY 14432
AGL Homes 315-462-9401
www.aglhomes.com
Due to continuous product development and improvement,prices,specifications,and materials are subject to change without notice or
obligation. Square footage and other dimensions are approximate. Images such as renderings,photos,and floor plans may be shown
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r PEWIT PLOT PLAN
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Applicant: t7Ot�1e5 V i(l���� I HAVE PERSONALLY MEASURED THE DISTANCE
A Location:9 /a 1p;oe_ A Ve- FROM THE PROPERTY LINES TO THE
Homestead Mobile Home Park PROPOSED STRUCTURE(S)OR SIGN(S)
9-1W
SIGNATOR ATE