RC-0002-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-0002-2017 Date Issued: Tuesday, April 11, 2017
This is to certify that work requested to be done as shown by Permit Number RC-0002-2017
has been completed.
Tax Map Number: 309.9-2-1
Location: 200 Luzeme RD
Owner: Homestead Village
Applicant: Homestead Village
This structure may be occupied as a: 14 ft, by 70 ft.mobile home
Lot 9 W indsong Drive By Order of Town Board
Homestead Mobile Home Park TOWN OF QUEEENNSBU�JRY
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, (i(,iVVytt V
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
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
14 INA Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-0002-2017
Tax Map No: 309.9-2-1
Permission is hereby granted to: Homestead Village
For property located at: 200 Luzeme 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
Tvce of Construction
Owner Name: Homestead Village Mobile Home $40,000.00
Owner Address: 200 Luzeme RD Total Value $40,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Homestead Village
200 Luzenne RD
Queensbury,NY 12804
Plans&Specifications
14 ft.by 70 R mobile home
Lot 9 W indsong Drive
Homestead Mobile Home Park
$117.60 PERMIT FEE PAID-TI41S PERMIT EXPIRES: Thursday,January 18,2018
(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 Towryef�u'�� bury; W es y�emrary 18,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
MOBILE HOME-APPLICATION Received
DATE: `�`� 1 Tax.Map ID
TAx MAP IDPermit No.
,t Permit Fee _ I,7(o(�
PROPERTY LOCATION: "�L't`l �"�z-'� f1.Z �`1 -.�_1.___._,
\\ '_ \ ,r ` D
NAME OF MOBILE HOME PARK: I- -C Ay AI UA v I',(a L�
PROPOSED DATE OF PLACEMENT: rp—\C 1 - -
!7 TOWN OF QU 'EfyS y
APPLICANT C'le � �.c..+�u 1n: UiLGiNG pyG�
ADDRESS sI ADDRESS Sano r
PHONE IfS ' -C'17 PHONE
NAME OF INSTALLER OR MOBILE HOME DEALER
ADDRESS: -C: kjX 1S� U),n�So
PHONE 9
CONTACT PERSON FOR BUILDING&CODES COMPUANCE: l�:na� 1 "t:•� Yi�4-� PHONE:
COMPLETE INFORMATION BELOW FOUND ON A"PLATE"OR"STICKER"WHICH IS AFFIXED TO THE MOBILE HOME
Insignia serial number
Name of Manufacturer I I e n
Place Approval Number
Model or Component Designation (New home only)
Date of Manufacture:
MOBILE HOME INFORMATION ZONING INFORMATION
Approximate Value of Home $ 4-'O,cg ) Zoning J) at 6)y
New Home or Replacement jVO- i V\Owv- Size of property i_fL by_ZZoL ft.
Size of Mobile Home IIA ft.by 7O ft. Existing buildings A/O
Singlewide or Doublewide S; Accessory buildings /VO
Number of rooms(exclude bath) s Storage buildings /VO
Number of Bedrooms �3 Detached Garage T=3
Number of Bathrooms Z Attached Garage 3
Gas Fireplace•,Woodstove or Wood Fireplace Setbacks Front yard: ft.
Rear yard; ft.
Side yard: ft.
Foundation Support Size Depth Water Supply Well:
,
Piers 21 �_ Municipal: YA-b "n
Runners _
Slab Septic Permit Required? yes —No
Procedure for placing and occupying a mobile home or modular home:
1. Application is submitted and review: 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 form" on Town website
5. Septic Inspection, if needed
6. Final electrical Inspection
7. Stairs & 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 site 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; Deposit$100.00 (refunded when all items are complete)
DEciaRanom 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 completed with,whether specified or not, and that such work is authorized by
the owner. Installer Warranty will be provided at time of Certificate of Occupancy.
Print Name: arn�j V. lr . itiencn _ Date:
Owner Agent C ntractor
Signature: Date: //t,//7
Special Conditions of Permit:
By: Code Enforcement Officer
2
NOTICE FILE COPY 309.9-2-1 RC2-2017
Homestead MH Park
ANCHORING OF MOBILE HOME Lot Winde Road
Lot 9 indsong Drive
FRAME IS REQUIRED PER Mobile Home
MANUFACTURERS SPECIFICATIONS
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
MODEL CASH HOUSE #1 Based on our limited examination,compliance
with our comments shall not be construed as TOWN �� Q#S �jy3 BEDROOM.2 BATH indicating the plans and speafications are in
NOMINAL SIZE: 14'x 74' full compliance with the Building Codes of BUILDING &ACTUALSIZE: 13'-4"x70'-0" New York State. aTOTAL AREA:933 SQ.FT. Reviewed B
Date:
?�Y
D DINING- BEDROOM #2 BEDRJ12'-4
Drtr . •wP I 9'-0"x 9'-10"
_ onf , , OPT --—- LIVING
MASTER BEDROOM ---- ,, � oaY ¢a -- _, -� i 13'-13"x 12'-4'
QI I13'-0' x 12'-4"
t
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John O'Brien
From: Jeff Reigle <jreigle@aglhomes.com>
Sent: Thursday,January 12, 2017 11:45 AM
To: John O'Brien
Subject: Homestead Village
John,
The footings for the 2 new homes proposed for Homestead Village MHP lot 9 and 63 will be drilled 24" round
and 48" deep, 8' on center 3500 psi concrete. The site will be topped with a 6 mil plastic vapor barrier and
covered with stone.
Thanks,
Jeff Reigle
AGL Homes, Inc.
P: (585)226-6150 ext. 319
F: (585)226-6059.
9 X - This email has been checked for viruses by Avast antivirus software.
www.avast.com
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INSTALL NO. u STATE OF NEW YORK
Nkff DEPARTMENT OF STATE
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: t 1
B. HUDlabelnumber. Wnn Serial number.Csl�—`'(-(
C. Retailer's name: IAC' t.
D. Retailer's address: r { '•S CKj "C!1 LC—rcr_ I F-? Cr, hr Lf-- bck' I r t.1,-11
E. Retailer's certificafiot�# AirC T 1 ( (`T �16 G Telephone#:
E Installer's name: ( l I F1 12 C E-5 &j - f L iL I
Cx I n s t all e r's ad d re s s: �� �jG� �l! 'eC'P.�- �/l L.E:r�i�'i� %%-^, ( l (_ fZ `�- Yti/N l�, � -��f5
e
l /L CG /
H. Installer's certification#: � �!v 7- G (ata � Telephone#:
I. Date installed: Municipality issuing building permit: t C
- (City,Town,Pillage)
J. Customer name and physical address (911)where home is installed: (y i/1(" C H(" iv)K r� "t F Sc
l,U/Pi �
SI�iC1t\;C—� %�.' � �`- :_.c_f-!v' CSL_%t;� �� ,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 tl}e Installer,whether contractually or by operation of law.
Printed Name of Person Signing,Seal:
SignatureofInstalleror '
Limited Installer. i
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)4744073.
DOS-1680(Rev.03109)
Yellow Copy—Department of State White Copy—Retain for Your Records Goldenrod Copy—Permitting Agency Seal—Affix to Home