2005-119 TOVN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
(zt Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number. P20050119 Date Issued: Tuesday, October 23, 2007
This is to certify that work requested to be done as shown by Permit Number P20050119
has been completed.
Location: 200 LUZERNE Rd
Tax Map Number. 523400-309-009-0002-001-000-0000
Owner. HOMESTEAD VILLAGE L P
Applicant: DONNA FLEWELLING
This structure may be occupied as a:
Mobile Home In Park 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 EXforcernlent
Planning Board 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: P20050119 Application Number. A20050119
Tax Map No: 523400-309-009-0002-001-000-0000
Pern ission is hereby granted to: DONNA FLFAAT.1.I,1NG
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 $5,000.00
4294 ROUTE 5 Total Value $5,000.00
CALEDONIA,NY 14423
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2005-119 DONNA FLEWELLING 115 ADIRONDACK STREET
1064 SQ FT 1990 MOBILE HOME
$38.84 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,March 22, 2006
(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 To of Que bu ;� T ,March 22,2005
, ,,
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
%S
Application for Permit— Mobile Home
Town of Queens&wy, 742 Bay Roac>; Queensbury, NY 12804 (518) 761-8256
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
Once Use
IName: File Permit No. OS j
i
Address: Fee Paid C
i
Reviewed By:47
Phone No.
Property Owner Information Parcel Information r,
Name: i j,� ` L ,, Proposed Date of Placement.-
Property Location:
Address:
�,f z� %���� "�r 4�- C, — Road,Street,Avenue
Name of Mobile Home Park:_ 0,,`�ter
r a. l:cable
Phone No. 2� , r l d
Tax Map Number: / � l
Mobile Home Information_ __. Zoning Information
f
Approximate Value of Home:
Zoning Classification:
New Home: Yes No
,� Size of Property. A ft.by $.
Replacement Home: ( x�/ No �
��----�� Existing buildings: Ic'� - ��
Size of Mobile Home: -/L� ft. by �ft. Setbacks: front yard ft.; rear yard ft.
Singlewide: Doublewide: Side yards fly_$.and ft.
Number of Rooms: (exclude baths)
Number of Bedrooms: Accessory Building(s): circle
Number of Bathrooms:
Detached garage: 1 car, 2 car, car
circle: Gas Fireplace/Woodsto,.v<Wood a Attached garage: 1 car, 2 car, car
Storage building: Yes No
Foundation Support: Other. ����^ ,���
TYPE SIZE&DEPTH Water Supply: well or e
Piers x
Runners x Is Septic Permit Required? Yes or No
Slab x
Further information requested on the reverse side of this sheet W
Name of Installer or Mobile Home Dealer. _
Address:
Phone No. 3
Complete information below found on a`date"or"sticker"which is affixed to the mobile home.
1. Insignia serial number a � (
2. Name of manufacturer <e-A 'z,Z S
3. Plan Approval Number:
4. Model or Component Designation:
(New Home OM19
5_ Date of Manufacture:
AFFIDAVIT -
- - Town of Queensbury ----State ofNew-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.
R
Signature:
owner,owner's agent,architect,contractor
Special Conditions of Perinit
By
Form: 11J1911999sh Code Enforcement Officer
w
Commercial Final Inspection Report
Office No.: (518) 761-8256 Date Inspection request received:
Queensbury Building& Code Enforcement Arrive: am/p Depart: am/pm
742 Bay Road, Queensbury,NY 12804 Inspector's Initials:
NAME: �rr� PERMIT#:
LOCATION: (�� DATE:
COMMENTS:
Y N NA
Chimney/"B"Vent/Direct Vent Location
Plumbing Vent Through Roof 6"/Roof Complete
Exterior Finish/Grade Complete 6"in 10' or Equivalent
Interior/Exterior Guardrails 42 in. Platform/Decks
Interior/Exterior Ballisters 4 in. Spacing Platform/Decks
Stair Handrail 34 in.—38 in. /Step Risers 7"/Treads 11"
Vestibules For Exit doors>3000 s . ft.
All Doors 36 in.w/Lever Handles/Panic Hardware,if required
Exits At Grade Or Platform 36(w)x 44" 1)/Canopy or Equiv.
Gas Valve Shut-off Exposed&Regulator 18" Above Grade
Floor Bathroom Watertight/Other Floors Oka
Relief Valve,Heat Trap/Water Temp.110 Degrees Maximum
Boiler/Furnace Enclosure 1 hr. or Fire Extinguishing System
Fresh Air Supply for Occupancy/Ventilation Combustion
Low Water Shut Off For Boilers
Gas Furnace Shut Off Within 30 ft. or Within Line Of Site
Oil Furnace Shut Off at Entrance to Furnace Area
Stockroom/Storage/Receiving/Shipping Room(2 hr.), 1 '/z doors
> 10%> 1000 s . ft.
3/4 Hour Corridor Doors&Closers
Firewalls/Fire Separation,2 Hour, 3 Hour Complete/Fire
Dampers/Fire Doors
Ceiling Fire Stopping, 3,000 s . ft. Wood Frame
Attic Access 30"x 20"x 30"(h),Crawl Space Access 18"x 24"
Smoke Vents Or Fan,if required
Elevator Operation and Signa e/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets
Handicapped Bath/Parking Lot Si na e
Public Toilet Room Handicapped Accessible
Handicapped Service Counters, 34 in., Checkout 36"
Handicapped Ramp/Handrails Continuous/12 in.Beyond [Both sides]
Active Listening System and Signage Assembly Space
Final Electrical
Site Plan/Variance required
Final Survey,New Structure/Flood Plain certification,if reg. �" c
As-built Septic System Layout Required or On File
Building Number or Tenant Address on Building or Drivewayhc`?�`,- e�e
Water Fountain or Cooler
Building Access All Sides b eable Surface 20'wide
Okay To Issue Temp. or er anent G iz,-
Okay To Issue C/C
L:\Building& Codes Forms\Building&Codes\Inspection Forms\Commercial Final Inspection Report.doc
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building &Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART7INSP
DATE INSPECTION REQUEST RECEIVED:
NAME: C
LOCATION:
DATE: L/ PERMIT 1 C
MOBILE HOME MODULAR HOME
FOOTINGS _ FOUNDATION _ BACKFILL_ FRAMING
N/A YES NO
V
I. foundation support, pier spacing
per manuf. ................. — � —
2. anchoring per manuf. ............... _ —
3. water line shut off ...................
4. sewer line support ®4 feet ....... _
5. heating crossover (dblewide) off grd. — — —
6. dryer vented outside ......................
7. skirting ventilated .................... — —
8. hot water relief valve piping outside — —
9. deck, notches, steps, railing ..... _ —
10. fiunace/hot water operating ........ j
11. garage fire proofing ..................
12. door closers ........................... — —
13. plumbing fixture ......................
14, foundation insulation (if appl.)...... — —
15. smoke detectors _
16. final electrical ... htig. —
17. variance required ..................... _
18. data plate okay ....................... _ —
19. mobile HUD seal okay .............. —
Model# Serial# ro
ManufacturerU�>
Date of Manufacturer 15n F)
OKAY TO ISSUE C/O YES NO
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC,�
Main Office 176 Doe Run Road-Manheim,PA 17545 e
MUNICIPAL CERTIFICATE - ELECTRICAL APPRO14AL
?erinit No........................................Cert. N2 89573 Cut-in Card No.............................
:)wner..........2)......... *Z-164**
'-ocation......& A01/2
installation Consisting of........................ ..................................... ... ... ........ ............. ..1�............. ...
AI-V-ein............
.......................................#......IP...............................................................................................................................
..................................................................................................................................................................................
InstalledBy........................................................................................Lic.No..................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
-ancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
ntroduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of mak' ,—P�pcctions at any time, and if its
e_rt_17t
i-ules are violated,the Company shall have the right to re no e 7th'�certificat 3ate... .............. .. ........................................
..................... INSPECTOR._kV..........................................................................
FINAL INSPECTION REPORT
MOSILE / IMOOULAR
Town of Que&m"
8uikiing & Code Enforcement
742 Bay Road
Queensbury, NY 12804 a
(518) 7614 256
ARRIVE: DEPART:° 10,NSP.
DATE INSPECTION REQUEST RECEIVED:
NAME:
t,OCATION:
DATE: PERMIT
MOBILE HOME MODULAR HOME
FOOTINGS_ POUNDATM 4 .RACKFIIL_ FRAMM
N/A . YES NO
1. foundation support, pier spacing /
per manuf. ................. � % —
2. anchoring per manuf. ...............
3. water line shut off ...................
4. sewer line support®4 fed ....... —
5. heating crossover(dblewide) off grd_ _ —
6. dryer vented outside ..:................... ✓ _
7. skirting ventilated ....................
8. hot water relief valve piping outside _
9. deck, porches, steps, railing ....... — —
10. furnacelhot water operating ........ _
11. garage fire proofing ..................
—_
12. door closers ........................... — � —
13. plumbing future ...................... _
14. foundation insulation (if appl.)...... _
15. smoke detectors _ ✓
16. final electrical _ � �� —
11,
17. variance required ..................... _
18. data plate okay .......................
19. mobile HUD seal okay ..............
Model# " /3eriai# —
Manufacturer c K V C Z
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building &Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
g r� r
ARRIVE: i? DEPART: INSP: +✓_`
DATE INSPECTION REQUEST RECEIVED:
NAME: _
LOCATION: /
DATE: ""_ PERMIT#
MOBILE HOME MODULAR HOME
FOOTINGS_ FOUNDATION _ RACKMI L_ FRAMING_
N/A YES NO
1. foundation support, pier spacing
per manuf. ........................ — —
2. anchoring per manuf. ............... .
3. water line shut,off ................... . — —_
4. sewer line support ®4 feet ....... — —
5. heating crossover (dblewide) off grd. ✓
6. dryer vented outside ...................... —7.. skirting ventilated .................... — —
8. hot water relief valve piping outside /V. I.,.�4TV
9. deck, pouches, steps, railing ....... Alee'7 yV..- z
,10. fiunace/hot water operating ........ _✓ —
11. garage fire proofing ..................
12. door closers ........................... -
13. plumbing fixture ...................... --A&-�
14. foundation insulation (if appl.)...... _✓� —
15. smoke detectors ....................... —
16. final electrical ........................ — —_
17. variance required ..................... — —
18. data plate okay ....................... V5 —
19. mobile HUD seal okay ..............
Model # Serial#
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YESQ NO
Comments:
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REVIEWE BY
DATE
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RSCHODER RIVERS Evergreen Professional Park
ASSOCIATES 453 Dixon Road,Suite 7, Bldg. 3
Consulting Engineers, P.C. Queensbury,NY 12804
Tel. (518) 761-0417
Fax. (518) 761-0513
Town of Queensbury August 14, 2006
Community Development Department SRA#04-488
742 Bay Road
Queensbury, NY 12804
Re: Arrowhead Equipment
Waste Water Disposal System
Attn: Dave Hatin
Dear Dave,
Schoder Rivers Associates has been retained by Arrowhead Equipment to provide design and
construction phase services for the new addition to their existing facility on Luzeme Road in
Queensbury, NY. As part of these services, we provided periodic construction review and
inspection services for the construction of the on-site waste water disposal system. This
included conducting additional percolation tests to determine the percolation rate of the on-site
modified soils.
We state that, to the best of our knowledge, information and belief, that the construction of the
on-site waste water disposal system has been completed in conformance with the construction
drawings and specifications.
If further information is required, please contact us.
Sincerely,
Shaun M. Rivers, PE
cc: William Ehlert-Arrowhead Equipment
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