2013-365 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: P20130365 Date Issued: Tuesday, September 10, 2013
This is to certify that work requested to be done as shown by Permit Number P20130365
has been completed.
Location: 200 LUZERNE Rd
Tax Map Number: 523400-309-009-0002-001-000-0000
Owner: HOMESTEAD VILLAGE L P
Applicant: KRISTY KING
This structure may be occupied as a:
Mobile Home In Park By Order of Town Board
Ls 7. I .se N TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property 1
owner of the responsibility for compliance with Site Plan, Variance, or (ThiK 'V
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
'� � 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130365 Application Number: A20130365
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: KRISTY KING
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 Mobile Home In Park $15,000.00
4294 ROUTE 5 Total Value
CALEDONIA,NY 14423 $15,000.00
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2013 -365 57 WINDSONG DR.
Mobile Home 14' x 66' Holly Park Serial 14702BFLCK Model 010P19473
$110.88 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,August 09, 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 Queensbury; Friday,August 09,2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
r/.. - - '
Town of Queensbury Building & Codesorrice Use Only 2p13
0 pG
MOBILE HOME APPLICATION Received:
Tax Map ID: , ,Q,9 -c)
A permit must be obtained before placement of mobile home on parcel. No Permit No.: / 3 3!a Jr
inspections will be made until a valid building permit has been issued. Permit Fee: $ a O, 'K
Applicant Kris-y kiA9 Property Owner /-I(/ /1n1e5//Ao/nes-44iPi/l -
Address //Z 74/7 e- eircA, ('. Address 17g/9S474/2f 6—
_
_hrl>a., 14/.e.., AJ! /P? %i eakei.2,4,,2/Y/5447,.3
Phone (4,/g) OS/8- 0(2_3$ Phone (5$'c7 2X-o/SO Et/ S/Y
Contact Person for Building&Code Compliance: 2,Ler tt LA.s c Day Phone:(58S)303-So?)(
Name of Installer or Proposed Date of Placement 4uyus7- /9; ge)/3
Mobile Home Dealer t- Aur i cam. (AvvAln S Name of Mobile Home Park MmieS/r/4-/ //,%//7o
Address i . S , _/, na. Property Location Au�ine �/Q ,r/yi /
Phone c >'9 _S7sE 773-1/7/ Tax Map ID ci7 \
hJtr e �q
Complete information below found on a "Plate" or"Sticker"which is affixed to the mobile home:
• Insignia serial number. /tP/95173
• Name of Manufacturer. J /�Y ,�y`//,
• Place Approval Number. /
• Model or Component Designation: (New home only)
• Date of Manufacture: /O 'S- 87
Mobile Home Information Zoning Information
Approximate Value of Home $ /SGOO Zoning
New Home or Replacement / 1�AGeinen Size of property _5R ft.x /,10 ft.
Size of Mobile Home �),�LP /z/ ft. by // ft. Existing Building(s)
Singlewide or Doublewide
6--
/n5-6 e..en'de Accessory Bldgs.
Number of Rooms(exclude bath) 3 Storage Building(s)
Number of Bedrooms 2 Detached Garage _ 1 car _2 car _3 car
Number of Bathrooms / Attached Garage _1 car _ 2 car _3 car
Gas Fireplace Setbacks Front Yard: An feet
Woodstove Rear Yard: /S feet
Wood Fireplace Side Yard: /O feet
Foundation Support Size Depth Water Supply Well
Piers Municipal )C
Runners_ — Septic Permit Required?
Slab _ _ NO
Town of Queensbury Building&Codes Mobile Home Permit 518-761-8256 •
^
Procedure for placing and occupying a mobile home or modular home:
1. Application is submitted and reviewed: 2 copies of plot plan and layout must accompany application, along with septic application
(if needed)and fee
2. Permit is issued-Permit card is placed on property
3. Footing forms are inspected before pouring concrete: Home is placed on foundation or piers
4. Arrange for electrical inspection-see"Certified Electrical For"on the Town's website
5. Septic Inspection,if needed
6. Final Electrical Inspection
7. Stairs and platform covering door width and door swing with handrails on both sides of platform and stairs are required for all
exterior doors
8. Final Inspection by Building&Codes Department
9. All mobile/manufactured housing must be anchored to the ground upon which they are sited per manufacturer requirements
10. Installer Warranty seal must be provided at the time of Certificate of Occupancy
11. If anchoring is not possible due to weather conditions or any other item,a Temporary Certificate of Occupancy will be issued: Fee-
$10.00; Deposit-$100.00(refunded when all items are complete)
✓1 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 completed with, whether specified or not, and that such work is authorized by the owner. Installer Warranty
will be provided at timelof Certificateiiof Occupancy.
Print Name: Roflet - C4.Wyen cc
Signature:
Owner,Owners A nt,Contractor
Date: c6/13r1/3
Special Conditions of Permit:
By: Code Enforcement Officer
Town of Queensbury Building&Codes Mobile Home Permit 518-761-8256
Queensbury Building & Code Enforcement — Manufactured / Modular Final Inspection
Office No. (518)761-8256 Arrive: am/pm rt 1.•,11 am/pm
Date Inspection request received: Inspector's Initials:
NAME Hi/Mers,f-coa p PERMIT*:
LOCATION: 51) l r h4Y Ag p,j, r DATE: 911°//i o [�3
Manufactured Home J l 111
Modular Home
Footings_ Foundation_ Backfill_ Framing_
Comments:
Yes No N/A_
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.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 dosers
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 �� 2 1 C /7`-
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./Perm.]
Model# Serial#
Manufacturer
Date of Manufacturer
L:1Pam Whiting12010\Buid ng Codes FonnslManufactured Modular Final Inspection 03 0410.doc
ill
,, 'Er idca3 ayci
Queensbury Building & Code Enforcement— Manufactured / Modular Final inspection
170
Office No. (518)761-8256 Arrive: C) amf m ��D J7 r�\' z---7
3 1 am/pm
Date Inspection request received: t� Inspector's Initials: /'��1,�
NAME: -K r\S hurl C}t PERMIT#C 13 - 3 Co 0—
LOCATION: S 0 ]vas 0-Acs DATE: g —3 0 - !3
Manufactured Home
Modular Home
Footings_ Foundation_ Backfill_ Framing
Comments:
Yes No WA_
Foundation support,pier spad�]g,
Per manufacturer ,1//
Anchoring per manufacturer 2'from ends
Water line shut off
Sewer fine support @@ 4 feet Li
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
Furnace/hot water operating ,f
Garage Fire proofing
Fire Door/Door closers
Plumbing Fixture/3'Vent through roof[Modular]
Foundation insulation[f applicable] �7
Smoke/Carbon Monoxide Detectors/Interconnected D <v�
Vi ri ce ui / \�e5tk��t's L
Variance required � .C/ ���`' ��W� y�,t
Data Plate okay CIS kar F ! .P.X r e ---'
Manufactured HUD seal okay V ` y
Warranty Seal after January 1,2006 1//
pp V
Installers Warranty Seal fi 5
18'x 24'access or 22'x 30'attic access t7 n
Vapor retarder under home 6 mil poly or other V
911 Street number 0 .------,,
Okay to issueC/C or C/0[Temp./Penn.]
Model# t(1)40,„4.1 7jSerial# l��y2R cILJC
Manufacturer 1,401,01 )€ "—
L:Pam
Date of Manufacturer v"") 'Whiting120101Bultding Codes Forms1Manufactured_Modular Final Inspection 03 04 10.doc
.,
Rot Kan sC : i "= 10 -
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NOTICE i
ANCHORING OF'MOBILE ROME o
FRAME I4 REQUIRED PER TOWN OF DUEENSBURY
MANUFACTUF1ERSSPECIFICATION BUILDING & CO S PT.
Reviewed I ,y:
Date: ' l� ��
TOWN OF QUEENSBURY
l
BUI DING DEPARTMENT
Based on our mited e:%;rnmation,comp ante `O
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