RC-000764-2017 TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-000764-2017 Date Issued: Monday, May 21, 2018
This is to certify that work requested to be done as shown by Permit Number RC-000764-2017
has been completed.
Tax Map Number: 309.9-2-1
Location: 57 WINDSONG DR
Owner: Homestead Village
Applicant: Homestead Village
This structure may be occupied as a: New Manufactured Home 980 sq. ft.
57 Windsong Drive By Order of Town Board
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 Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
4 �;, ,,, 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-000764-2017
Tax Map No: 309.9-2-1
Permission is hereby granted to: Homestead Village
For property located at: 57 WINDSONG DR
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
New Manufactured Home 980 sq.ft.
57 Windsong Drive
$117.60 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,December 13,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of ueensbu /�Ved s a er 13,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only ,,//
MANUFACTU Permit#:'�v 7(7 4o( -7
PERMIT APP II l ! �=P Fee:$ ,
1t7 &o
Town of(Zcensbury
742 Bay Road,Queensbury,NY 12804 DEC 0 8 2017 F e:$ I Gr
P:518-761-8256 www.gueensbury.net ellIn
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TOWN OF OUEENSS RYvoi e#:
0O' 7MUNITY l"EVELOPP
Project Location: � �+' '=j �� Tax Map ID #: ,
Name of Park: It Proposed Date of Placement: 1
CONTACT INFORMATION:
• Applicant:
Name(s):
Mailing Address, C/S/Z: .' NTCcl
Cell Phone: IT ) s3T-W1 ] Land Line: � )
Email:-
Wimary Owt er(s):
Name(s): L-p
Mailing Address,CC`S/Z: PS(,)x !S�A A r) ., .K"y IWAM
Cell Phone: (s ) '303 11 Land Line: � )
Email:
Contractus):
Business Name:
Contact Name(s): MgA-
Mailing Address* :
Cell Phone: Land Line: � )
Email:
Cophl� �rr-:$wilding & Code Compliance: �� , -
Cell .">-„'K 3 -+OIL!I Land Line: � )
Frnail:
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017
f i 1
MANUFACTURED HOME INFORMATION:
(INFORMATION FOUND ON THE PLATE OR STICKER LOCATED IN THE HOME):
Insignia serial #: 11
Name of Manufacturer:
Place approval#:
Model or component designation (New Home Only):
Date of manufacture:
ADDITIONAL INFORMATION:
1. Approximate Value of Home: $
un°�� cirri vie.S
ovi
2. Is the home NEW y` ora REPLACEMENT ?
3. Single-wide X_ or Double-wide Size: LA ft.X ft.
4. Foundation support(choose one): Size L Depth
�CPiers: t
Slab:
5. Is the home being placed on a private lot? No Yes_K (if yes,you must provide stamped engineered
drawings of the permanent foundation plan)
6. Total#of rooms(exclude bathrooms): 2- ;#of bedrooms:-;#of bathrooms:
7. Additional heat source? No Yes Choose one, if yes: gas fp A, woodstove_ wood fp_
8. Are there any other/existing buildings on the property? Nom Yes ; Explain:
9. What is the water source? =BL PRIVATE WELL
10. Is the parcel on SEWER or a PRIVATE SEPTIC system? riUz.�'4-�
11. Do you need a septic permit application? No 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: t'�c�Ort,�Ytric
SIGNATURE: DATE: )
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017
INSTALL NO. i T 0 STATE OF NEW YORK E idw ` '"i.
DEPARTMENT OF STATE
,,1 ONE COMMERCE PLAZA
I .�e, "t2L, 20\-)- 99 WASHINGTON AVENUE ' AUG 22 2019
ALBA NY,NY 12231
s a it nl ;�lUEE ISBUI Y
INSTALLER'S WARRANTY SE BUILDING&C0!p0
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTME OF TA
,❑ NEW MANUFACTURED(HUD CODE) 0 RELOCATED MANUFACTURED(HUD CODE)
A. Manufacturer's name: l'- '
B. HUD label number: i '•`" ` ` ' t ' ' - -) -i i F - i rt _�", ,, ,� , ;,
' Serial number: �'' ' �' .•
C. Retailer's name: 'I1i-7! • k, '
- _ D. Retailer's address: le' . ( -`
E. Retailer's certification ` •'kt- t� ' ':' , 't.• '`' ..•,�� Telephone#: 3 �"''—'-f i-( '`
F Installer's name: 1 t�:}-'f ,= - { i 4 I t,} ' ,-- -
Gc Installer's address: _ . ,��; ; 'l'', 1 `, !,t ` t ;'``: 1. r', t t't: . i t ..,ri .{, ,, { `'
H. Installer's certification#: ) - . "�"`---I-1, '-r' . — S"--c„ii i Telephone#: ‘ ' -1' `y - •=
L Date installed: '" _'11` 1 i r, Municipality issuing building permit: V-1 �''- ''''ri i
,., r• ,t (City,Town,Village)
J. Customer name and physical address (911)where home is installed °- `4'.. ` 'i l ;'' ,1)
1i Tt ', ; i I1\. ' `. .1 , '; i.'.+`r tt 1i1;',;lt
i ''� 1 ,New York.
y
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.
r
Printed Name of Person Signing Seal:`• 1 ' : _ r_ - " , ± ir,- r
Signature of Installer or t r` .' 1
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—Departmentof State White Copy—Retain for Your Records Goldenrod Copy—Permitting Agency. 6 __: Seal—Affix to Home
309.9-2-1 RC-000764-2017 E OWE
Homestead Village MHP U DVVL
57 Windsong Drive 980 S.f. DEC 11 2017
New Manuf. Home TTOWN OF QUEENSBURY
BUILDING&CODF-S
MODEL CASH HOUSE#1
3 BEDROOM,2 BATH
NOMINAL SIZE: 14'x 74'
ACTUAL SIZE: 13'-4"x 70'-0"
TOTAL AREA:933 SO.FT.
.-ILE COPY I
3661V
89 BEDROOM #2 TUB BEDROOM #3
DINING 9'-0"x 8'-10"
OPT. #--I OPT, LIVING 8'-0"x 12'-4"
MASTER BEDROOM D Y I I WASH 13'-6"x 12'-4"
0
0 x FPC
FIST-0 x 712p-4 7 KITCHEN
IW: REF'G
3b51VL 3WIVE 3036V V 3
hit' I--
TOWN OF QUEENSB, TOWN OF QUOEW
BUILDING DEPARTMENT- BUILDING &
NOTICE Based on our limited exannination,compli
ANCHORING OF MOBILE HOME with our comments sh,3P 1 iot be consti(le%J a-� Reviewed By:
indicating the plans ano specifications ;Irp in
FRAME IS REQUIRED PER 46' full compliance with the building CoJes of Date:
MANUFACTURERS SPECIFICATIONS New York State.
APPROVER'S SEAL MODIFICATIONS MODEL J-952-AGL-CASH HOUS Vf
14'X 74'2 BED,2 BATH
Or TITANT' ______ TITLE LITERATURE PLAN L-1 01
■ ____
PROPRIETARY AND CONFIDENTIAL DRAWN BY D.BASLER�TATE 10-04-16
HOMES THESE DRAWINGS AND SPECIFICATIONS ARE ORIOINAL.
PROPRIETARY AND CONFIDENTIAL MATERIALS Of CHAMPION
A PION SCALE.1/8"=V-W
1p.0,60)(177'- .12&20SANGERFIELD,NYT:4651 OPYRIGHT�19-16-2012 BY CH
t Cn Syrrlbo�- --------___-----Symhool NOTES ___ _
G/ `'� ■ y.
MAIN BEAM PIER O SORVAL1 OPENING t�l Cnecicag The Sml Capacny Before The Home Is Setus
1 \ \ IFor F Oeakrs ResSensi ham
2.1 for footing Sizes See Cnampm Installation Manu.
. I ®MARRIGE LINE OPENING PIER ®MARRIAGE LINE PIER gd For Different Pier Spapng See Champion Installation Manual.
"TMs pier placement drawing is not a
foundation design see current
CHAMPION Installation Manual and
its addendum(s)for foundation design."
70'
2 10 18' 26' 34' 42.' 50 58' 64' 68 2
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'2' AL ' MODIFICATIONS _—"L_:-MODEL:J_952-AGL-CASH HOUS fft I
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T TITAN _- - ,4'X74'28 PRINT
PR-101
_ TITLE PIER PRINT
■ HOMES -- _ -
PROPRIETARY AND CONFIDENTIAL DRAWN BY D BASLER DATE.10-04.16
THESE DRAWINGS AND SPECIFICATIONS ARE ORIGINAL
PROPRIETARY AND CONFIDENTIAL MATERIALS OF CHAMPION.
P,O BOX 177 RT.12&20 SANGERFIELD 5b NY 134COPYRIGHT.1976m2W BY CHAMPION SCALE 1/8^=1'4'
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I HAVE PERSONALLY MEASURED THE DISTANCE
Applicant: �, —tl(-s1 FROM THE PROPERTY L ;�-5 TO THE
Location: PR P S STRUCTURE(S)Or SIGN(S)
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