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2009-122 J TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 4E Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20090122 Date Issued: Friday, December 21, 2012 This is to certify that work requested to be done as shown by Permit Number P20090122 has been completed. Location: 158 LUZERNE Rd Tax Map Number: 523400-309-005-0001-001-001-0000 Owner: D&G MANAGEMENT LLC Applicant: D&G MANAGEMENT LLC This structure may be ocA* QkWS Mobile Home In Park By Order of Town Board '3 1 S �-L 3OL rb ,-sV� 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 )j W 44�e— other issues and conditions as a result of approvals by the Planning Board Director of Building&Co EnfoNlernent 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: P20090122 Application Number. A20090122 Tax Map No: 523400-309-005-0001-001-001-0000 Permission is hereby granted to: D&G MANAGEMENT LLC ANN JOHNS For property located at: 158 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 QueensburyZoning Ordinance. Type of Construction Value Owner Address: D&G MANAGEMENT LLC PO BOX 2488 Mobile Home In Park GLENS FALLS,NY 12801-0000 Total value Contractor or Builders Name/Address Electrical Inspection Agency Plans &Specifications 2009-122 1680 SQ FT MOBILE HOME IN PARK $100.80 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday, April 20, 2010 (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 T of eens ry, G r#day,, April 20, 2009 SIGNED BY `' t� for the Town of Queensbury. Director of Building&Code Enforcement _ - --------------- OFFICE USE ONI_Y TAX MAP NO, PERMIT NO. - —DATE ISSUED: PERMIT FEE.?ntr _ APPROVALS: ZONING TOWN CLERK r r , r , r r y r r , r MOBILE HOME -APPLICATION FOR PERMIT: 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:Ulm 0 10�n S Name: -DGn19, Address:�L (,t Address: No M (A-)111 JS12-X 04 LtAMO kk QVAIAoi�� m — I __ Phone No. , 79' �6 — Phone No. /. Parcel Information . id :j 0 rb(t. -h� Proposed Date of Placement:. Property Location: L `�%`� Road,Street,Av ue Name of Mobile Home Park: L�l A w:.j/S (if applicable) Tax Map Number: ............................................................................................................................................................................._._............................................................................................................................................................. ........... Mobile Home Information Zoning Information Approximate Value of Home: $ � trh�� Zoning Classification: New Home:>(Yes ❑No Size of Property: ft. by ft. Replacement Home: XYes ❑No J �r Existing buildings: Size of Mobile Home: ft. by ft. Setbacks: front yard ft. rear yard ft. side yards ft. and ft. Singlewide: Doublewide: _ Number of Rooms: (exclude baths) f Accessory Building(s): Number of Bedrooms: Number of Bathrooms: Detached garage:❑1-car ❑2-car ❑ car ❑Gas Fireplace❑Woodstove Wood Fireplace Attached garage: ❑1-car ❑2-car ❑ car Foundation Support: Storage building: ❑Yes No Type Size & Depth Other: Piers Runners Water Supply: ❑Well ❑Municipal Slab9. Q X �Q �r� Is Septic Permit Required? ❑Yes ❑No ........ . ea......................................................................................................................... Continued on page 2 Town of Queensbury - Coninlitnity Development Office • 742 Bay Road, Queensmigl, ;v i i.,ou4. 0,0(41464 Name of Installer or Mobile Home Dealer: Vah4JED M9k1tkLf,,,d Address: IJ-7a C 9 r*/,�C-t-l-,do 12Ka4 Phone: 79U -/a(o Complete information below found on a"Plate"or"Sticker"which is affixed to the mobile home: ✓ Insignia serial number: ✓ Name of manufacturer: ✓ Plan Approval Number: 0 ` ✓ Model or Component Designation: (,)0/600')sI (New here only) ✓ Date of Manufacture: ©O AFFIDAVIT Town of Queensbury State of New York County of Warren 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 complied with, whether specified or not, and that such work is authorized by the owner. Signature: yet,9,� Owner, Owner's Agent,Architect, Contrac or SPECIAL CONDITIONS OF PERMIT By: Code Enforcement Officer y� Town of Queensbury - Conintwiity Development Office • 742 Bay Road, Queensbury, N)'121804 Queensbury Building & Code Enforcement— Manufactured / Modular ' al Inspection Office No.(518)761-8256 Arrive: LA . rt L--/,rp � Date Inspection request received: Inspector's Initials: �_-- NAME: Z��T tA 1E*TL6LF— C-0 RQ PERMIT ca - l zz LOCATION: cam, 0LR W50k—A\ �bPrQ DATE: ll- ZD -I Z Manufactured Home Modular Home Footings_ Foundation_ Backfill_ Framing— Comments: Yes No WA Foundation support,per spacing, Per manufacturer Anchoring per manufacturer 2'from ends Water fine shut off Sewer line support Q 4 feet Heating Crossover jdoublewide}off grd. Dryer vented outside Skirting ventilated 1 ea.ft.oer 1,500 sa.ft. Hot water relief valve piping outside Deck,porches,steps,railing Fumacelhot water operating Garage Fire proofing Fire Door/Door closers Plumbing Fixture/3"Vent through roof(Modular] Foundation insulation fd applicable] Smoke/Carbon Monoxide Detectors/Interconnected Final Electrical © , '1a C) ,!�1 v� Cj:� , Variance required Data Plate okay Manufactured HUD seal okay Warranty Seal after January 1,2006 Installers Warranty Seal 18"x 24"access or 22"x 30"attic access Vapor retarder under home 6 mil poly or other �C�l�` , ►1111111'111►11►1►1 i►►111�►�� �.. 911 Street number JacksonCorp- ?.AstOkay to issue C/C or CIO[Temp./Perm.] �Judyage p0Model# Serial# Mortgage St'°37gp2 Manufacturer KnoX�►Ile,TN Date of Manufacturer v LAPam Whiting1201016uilding Codes Forms%lanufackmW Modular Final lnspecbon_03 0410.doc Queensbury Building & Code Enforcement— Manufactured / Modu inal Inspection MA\ClR F—L -F1QoRTF '--�Z�-�3Z10 rr,r Office No.(518)761-8256 Arrive: �7i�� a Date Inspection request received: Inspector's Initials: �/ r', NAME: �,�� M l 1C�� CORP P PERMIT# ZZ LOCATION: , ,`71�C{�R(�j�; , RL�'A(> DATE: L/ 1 Z ZO! Z-- Manufactured Home Modular Home Footings_ Foundation_ Backfill_ Framing_ Comments: Yes No WA Foundation support,pier spacing, Per manufacturer Anchoring per manufacturer Z from ends Water fine 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 closers Plumbing Fixture/3"Vent through roof[Modular] Foundation insulation[d applicaW 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 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 CIC or CIO[Temp./Perm.] Model# Serial# Manufacturer Date of Manufacturer L Wam Whiting120100uilding Codes FormsWlanufactured Modular Final lnspection_03 04 10.doc VFW o-)6A d 0 m Queensbury Building & Code Enforcement— Manufactured / Modular i I Inspection Office No. (518)761-8256 Arrive: a rt (. am/ rri J Date Inspection request received: Inspector's Initials: NAME: — PERM #`'` 01— LOCATION: r�� C� DAT Manufactured Home Modular Home Footings—. Foundation_ Backfill Fra i — ems— Comments: Yes No WA Foundation support,pier spacing, Per manufacturer Anchoring per manufacturer Z from ends Water line shut off Sewer line support @ 4 feet Heating Crossover[doublewide)off grd. Dryer vented outside r Skirting ventilated 1 so.ft.ner 1.500 so.ft. a Hot water relief valve piping outside Deck,porches,steps,railing Fumace/hot water operating Garage Fire proofing Fire Door/Door closers Plumbing Fixture/3"Vent through roof[Modular] Foundation insulation[d applicable] �v {� �', `t- ,✓� Smoke/Carbon Monoxide Detectors/Interconnected V , Final Electrical Variance required Data Plate okay Manufactured HUD seal okay Warranty Seal after January 1,2006 xff Installers Warranty Seal 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 C/O[Temp./Perm.] Model# Serial# Manufacturer Date of Manufacturer L:1Pam Whiting12010113uRding Codes FormsWanufactured Modular Final Inspection_03 0410.doc } Queensbury Building & Code Enforcement— Manufactured / Modular Final Inspection Office No. (518)761-8256 Arrive: Z'- 16-ar:Depart: Date Inspection request received: Inspector's Initials: NAME: ZU6 �.t>R 1 C��C�� � , PERMIT* C)C� _ I z z- LOCATION: DATE: Manufactured Home Modular Home Footings— Foundation_ Backfill_ Framing_ Comments- Yes No WA 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 sa.ft. Hot water relief valve piping outside Deck,porches,steps,railing Fumace/Imt water operating Garage Fire proofing Fire Door/Door closers Plumbing Fixture/3'Vent through roof[Modular] Foundation insulation[rf applicable] Smoke/Carbon Monoxide Detectors 1 Interconnected Final Electrical Variance required Data Plate okay Manufactured HUD seal okay Warranty Seal after January 1,2006 Installers Warranty Seal 18'x 24'access or 22"x 30'attic access Vapor retarder under home 6 mil poly or other 911 Street number C Okay to issue C/C or CO[remp./Perm.] Model# Serial# CJ ` 1 Manufacturer V,,J°� I N O D Date of Manufacturer l-APam Whiting\2010\Buikiing Codes FormsWlanufactured Modular Final lnspec ion_03 0410.doc Z-\<DN tJ,0 eensbury Building & Code Enforcement Manufactured / Modular Final Inspection Office No. (5118 61-8256 Arrive: Date Inspection request received: Inspector's Initia . NAME: P Zt v _ PERM! bi ►�1 n a k LOCATION: DATE: \In ZZ-\Z_ Manufactured Home Modular Home to tAckiz\6%'\F- Footings_ Foundation_ Backfill_ Framing_ - kA l ka t(,3q Comments- Yes No WA Foundation support,pier spacing, 2-0 10 Per manufacturer Anchoring per manufacturer Z from ends Water fine shut off `!^ Sewer line support @ 4 feet D 1 -5 Heating Crossover[doublewide}off grd. ✓✓✓ Dryer vented outside IVA le� Skirting ventilated I so.ft.w 1,500 sa.ft. Hot water relief valve piping outside A(P—1 Deck,porches,steps,railing O �e R �- Fumace/hot water operating Garage Fire proofing _® Fire Door/Door closers Plumbing Fixture/3'Vent through roof[Modular] Foundation insulation[d applicable] Smoke/Carbon Monoxide Detectors/Interconnected Final Electrical Variance required � Z Data Plate okay Manufactured HUD seal okay Warranty Seal after January 1,2006 Installers Warranty Seal 18"x 24'access or 22'x 30'attic access o Vapor retarder under home 6 mil poly or other 911 Street number �� tJ�® �� I�O�T6►R(-a� Okay to issue C/C or CIO[temp./Perm.] �o MP'�,rJ`� Model# Serial# Manufacturer Date of Manufacturer LAPam Whiting\2010\Building Codes FormsNanufactured Modular Final lnspecbon_03 0410.doc CS .� /Z2: CS CS I have seen or observed, or believe I saw evidence of, all oblects such as houses, wells, trees, fences, etc., shown or) this drucument, I also represent that I have -,Ily fnc,.asured the distances set futh on the diagram."persona C ivix SIGINATURE DATE U Go CO