RC-000763-2017 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-000763-2017 Date Issued: Monday, April 23, 2018
This is to certify that work requested to be done as shown by Permit Number RC-000763-2017
has been completed.
Tax Map Number: 309.9-2-1
Location: 68 ALPINE AVE
Owner: Homestead Village
Applicant: Homestead Village
This structure may be occupied as a: 980 sq. ft. manufactured home
68 Alpine Avenue By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the lot
property owner of the responsibility for compliance with Site Plan,
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
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000763-2017
Tax Map No: 309.9-2-1
Permission is hereby granted to: Homestead Village
For property located at: 68 ALPINE AVE
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
Tyne of Construction
Owner Name: Homestead Village Mobile Home $40,000.00
Owner Address: 200 Luzerne RD Total Value $40,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Daniel Hunt
36 Brick Oven RD
Queensbury,NY 12804
Plans&Specifications
980 sq.ft.manufactured home
68 Alpine Avenue
$117.60 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,December 13,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of ens /fedn y e er 13,2017
k aSIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
MANUFACTURED HOME Permit#:
PERMIT AP mit Fee:$ (�. (o U
Town of Queensbury r, C E O E
742 Say Road,Queensbury,NY 12804 (� Lam' 1
U
le
Fee:$ v1P:518-761-8256 www.gueensbury.net DEC 0 8 20V 1ice#:
TOWN OF QUEENSBU
C010MUNITY DEVELOPMENT
Project Location: �`� 1�� Tax Map ID #: 30:7, 0/-.) —1
Name of Park: �f� �d \��A� Proposed Date of Placement: 11-7
CONTACT INFORMATION:
• Applicant:
Name(s): ��.�t�- t-��r• �i.Yl��t
Mailing Address, C/S/Z: 1 i`
Cell Phone: ( Sl ) : ` t Land Line: r� )
Email:
• Prima Owner (s):
Name(s): pax a X
Mailing Address, C/S/Z: —, iv �r- CHILI
Cell Phone: ( �fa ) 3c � t i Land Line: � )
Email: \q 'w1' 4tC'AVA ,4-, 4 .►� - ccm
• Contractor(s):
Business Name:
Contact Name(s): S
Mailing Address, C/S/Z:
Cell Phone: ( "t�� ) tai^ �t'31 Land Line: t )
Email:
Contact Person for Building & Code Compliance: wne
Cell Phone: ( 1`S ) '73'�-- 7tl17 Land Line: 1 )
Email; m��•
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017
MANUFACTURED HOME INFORMATION:
(INFORMATION FOUND ON THE PLATE OR STICKER LOCATED IN THE HOME):
Insignia serial #:
Name of Manufacturer:
Place approval#:
Model or component designation (New Home Only):
Date of manufacture: 1,21L
ADDITIONAL INFORMATION: n j f)OV aVAVW .
1. Approximate Value of Home: $ L16,
2. Is the home NEW X_ or a REPLACEMENT ?
cx\
3. Single-wide or Double-wide Size: M_ft.X Z ft.
4. Foundation support(choose one): Size Depth
Piers: T 1
Slab:
5. Is the home being placed on a private lot? No Yes '4_ (if yes,you must provide stamped engineered
drawings of the permanent foundation plan)
6. Total#of rooms(exclude bathrooms): cam;#of bedrooms: ;#of bathrooms: �C
7. Additional heat source? No Yes >(— Choose one, if yes: gas fp woodstove_ wood fp_
8. Are there any other/existing buildings on the property? No �< Yes ; Explain:
9. What is the water source? PUBLIC 3 PRIVATE WELL
10. Is the parcel on SEWER or a PRIVATE SEPTIC system? 17)T vc�
11. Do you need a septic permit application? No >e, Yes
DECLARATION:
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 NYS Building Code,the Zoning Ordinance and all other laws pertaining to the
proposed work shall be completed with
I have read and agree to the above:
PRINT NAME: 1 L�1t(� �ull%'Aw L
SIGNATURE: DATE: 112
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017
INSTALL NO. 2 •` ;h tr't
e`'`)L- :`°Q STATE OF NEW YORK
{ DEPARTMENT OF STATE D E E E
Y 4N . r' ' c 3-)Q(1.— . ONE COMMERCE PLAZA
l 'O j 99 WASHINGTON AVENUEI]
ALBANY,NY 12231 AUG 2 2 20�9 i
INSTALLER'S WARRANTY SEAL OoA OF= E ;wSc U y
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT QFST ?.`11? `" .7z °�,e7-S
D\ NEW MANUFACTURED(HUD CODE) 0 RELOCATED MANUFACTURED(HUD CODE)
--t- ; -
A. Manufacturer's name: ' f r --1 I
B. HUD label number: ,, t ; }y ' i" `_-- `"'1. Serial number: - t °� r 0i"r a_. i 'Y_,4
C. Retailers name:
' X1, is�le•--irl - P ,i '"i 1 ( (� ',ilk r r x ,
D. Retailer's address: -. t (:..40 fit`'\:. .., U t . t f,` a,�.. -t '•�'J'°`
E.- Retailer's certification#: fit. Telephone#: " -'' -- - -y , ' `}
F. Installer's name: I- ` i , `�.' , ` • -- t /
G Installer's address: Li ( "- �.a �, El _ i` v'1 a='� "': _ t1' : is i_ _}
H. Installer's certification#: '- {,\ - '"- t L `-1" Telephone#: - -F - -`- '---1 ',, t,
I. Date installed: { t` I I� t Municipality issuing building permit: 1' - . 4 1,..,-, '
(City,Town,Village)
J. Customer name and physical address (911)where home is installed: ---,"'.\- ! i 1`f)F '`.,4'• ''':.'.:" ,
.., ` t � ' 1)� r ' I,, , iv 4, ,.t • - - _tik . ,NewYork..
i
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 o_r byoperation of law - -
Printed Name of Person Signing Seal: - .% l,4-—r, --- "-_`1 J , c'- -_ - -
s g
Signature of Installer or `� , -F {r -!- -
Limited Installer: s 14 .' , v�,ry .r r`.� _ �.. - _ _ - -- _._`- - - ti.
If you have a problem with your home,you should first,conti&yoiinnstaller or retailer If.the problem is not resolved bythe Installer or -,
Retailer you can contact the Department tof State at(518)474=4073.:. ' ";= =
DOS-1680(Rev 03/09)
Yellow Copy—Department of State White Copy—Retain for Your Recoi ds '' _-Goldenrod Copy—Permitting Agency 7 . - _= Seal—Affix to Honie•-
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BUILDING&CODES
MODEL CASH HOUSE#1
3 BEDROOM,2 BATH N E
NOMINAL SIZE: 14'x 74' — O
ACTUAL SIZE: 13'-4"x 70'-0"
TOTAL AREA:933 SO.FT. >
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TUB__ bINING BEDROOM #2 BEDROOM #3
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_OPT ii oPT- -- - - LIVINGORv I 1 WASH UR 13'-6"x 12'-4"M "oI7 -H" KITCHEN_ - - OPT
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3 TOWN OF QUE S
�' r 13UILDTOWN OF DEPARTMENTQUEENSBURY BUILDING &
NOTICE BUILDING DEPARTMENT
Based on our limited examination,compliance Reviewed B
ANCHORING OF MOBILE HOME with our comments shah
not e construed as
indicatinq the pians and specifications are In
FRAME IS REQUIRED PER lull compliance with the Building Codes of Date.
MANUFACTURERS SPECIFICATIONS New York State. }
APPROVER'SSEAL MODIFICATIONS MODEL J-952-AGL-CASH NOUS `tt�
T TITAN` ,4x74'2 BEDZBATti
TITLE LITERATURE PLAN L-1 01
■ HOMES -_ _ _ _W _ _
PROPRIETARY AND CONFIDENTIAL DRAWN BY D.BASLER DATE.10.0446
1 HF S[DRAW INGS ANO SPECIFICATIONS ARE ORIGINAL.
I'It_;f,RIF IARV AND CONFIDENTIAL MATERIALS OF CHAMPION. SCALE:118"=1'4"
OX 177,RT,12&20 SAN ERFIELDNY 13455 PV RIGHT.IV6.2012 BY CHAMPION
Symbol Symbol ...._. NOTES _
P �� ■MAIN BEAA1 PIER O SIDEN ALL OPENING s Th ng The Sal Capacity Before The Home Is Setup
n�1�( Iy�T 15 The Jesters Responsibidty.
-� �.—.-__ _— -------- --- 2.)For Fooling Saes See champion Instal anon Manual.
®MARRIAGELINEOPENINGPER ®MARRIAGELINEPIER l3_)FaaAerenlPreSpaDngSee ChampwnlnstalalronManu�.
.This pier placement drawing Is not a
foundation design see current
CHAMPION Installation Manual and
its addendumis)for foundation design."
70'
2 __. 10' -26' -34'_, _- 42 50_ -- 58_ 64'_ 68' 2
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34' 42' 50' 58' I 64-1 682'
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APPROVER'S SEAL MODIFICATIONS MODEL J-952-ACL-CASH HOUS
--- -- _. 14'X 74'2 BED.2 BATH
T TITAN - TITLE PIER PRINT PR-101
■ HOMES _ _
PROPRIETARY AND CONFIDENTIAL DRAWN BV.D.BASLER DATE 10-04.16
THESE DRAWINGS AND SPECIFICATIONS ARE ORIGINAL ----------
` -_ PROPRIETARY AND CONFIDENTIAL MATERIALS OF CHAMPION. SCALE'1/8°=1'-0"
pORT.128�20SAN ERFIELO NY 13455 COPYRIGHTe19?6-2012 BY CHAMPION
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Applicant: T. lvcr`iu sL
Location: NATURE
s Homestead Mobile' me Park
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