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2005-395 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20050395 - Application Number: A20050395 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: TARRY PASC O 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 NY S Uniform Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: HOMESTEAD VILLAGE L P Mobile Home In Park $8,000.00 4294 ROUTE 5 Total Value CALEDONIA, NY 14423 $s,000.00 Contractor or Builders Name / Address Electrical Inspection Agency Plans&Specifications 2005-395 LARRY PASCO 123 ADIRONDACK STREET 1196 SQ FT 1986 MOBILE HOME SERIAL 916883A16883B POLORAN HOMES $46.76 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday, June 06, 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 Town Quee bury 0 y une 06, 2005 SIGNED BY Ir for the Town of Queensbury. Director of Building&Code Enforcement RECEIVED Application for Permit— Mobile Home JUN 0 6 2005 Town of Queensbwy, 742 Bay Road, Queensbury, IVY 12804 (518, ft- 6tUEENSBURY BUILDING AND CODE 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 In formtion Office Use File l �(� 3�S f Name: �—�-�� _ ,� � e Permit No. Address: ®� i, ) , �, Fee Paid �j/- C�1 ��-2s� L� r. Z l0 —7(0 Reviewed By: Phone No. j G Property Owner Information Parcel Ir formatio Name: Ippp ed Date of Placement: -' l G� Property Location: k � Address: Road,S>zeet,Avenue Name of Mobile Home Park: mt -e �c C.fapplicable) Phond No. _ Tax Map Number: Mobile Home Information __ _— Zoning Information Approximate Value of Home: s_�� j _ YX Zoning Classification: New Home: Yes A / `-� Size of Property. ft.by ft. Replacement Home: Yes No Existing buildings: Size of Mobile Home: �'� ft. by `1 ft Setbacks: front yard ft.; rear yard ft. Smglewide: Doublewide: �� Side yards ft.and ft. Number of Rooms: (exclude baths) /r, S` d Number of Bedrooms: �_ Accessory Building(s): circle Number of Bathrooms: Detached garage: 1 car, 2 car, car circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1 car; 2 car, car Storage building: Yes No Foundation Support: Other. TYPE SIZE&DEPTH Water Supply: well or municipal Piers s Runners x Is Septic Permit Required? Yes or No Slab x Further information requested on the reverse side of this sheet �► Name of Installer or Mobile Home Dealer. Address: Phone No. Complete information below found on a"plate"or"sticker"which is affixed to the mobile home. 1. Insignia serial number. T Z 6 2. Name of manufacturer: Al', r 3. Plan Approval Number: 4. Model or Component Designation: (New Home ONLY) 5. Date of Manufacture: - AFFIDAVIT Town of QaeensburY 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 irk is authorized by the owner. / Signature• er,owner' gent,architect,contractor Special Corn& ions of Permit By Farm: 11/19/1999sh Code Enforcement Officer W INSPECTION REPORT BILE / MODULAR Town of Queensbury Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 1 ARRIVE: DEPART NSP: DATE INSPECTION REQUEST RECEIVED: [NAME: LOCATION: C7 DATE: Q 3 0'-0-5 PERMIT - A5 MOBILE HOME MODULAR HOME FOOTINGS - FOUNDATION - BACKFILL_ 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 — — 9. deck, porches, steps, railing ........ _ 10. furnace/hot water operating ........ _ 11. garage fire proofing .................. 12. door closers ........................... — 13. plumbing fixture ...................... 14. foundation insulation (if appl.)...... — — — 15. smoke detectors ...... ....-. 16. final electrical � n. — — 17. variance required ..................... — — 18. data plate okay ....................... — — 19. mobile HUD seal okay .............. Model # Serial # Manufacturer Date of Manufacturer _Zt OKAY TO ISSUE C/O YES NO Comments:� � )"� }F kA \ ;-0 �� _ FINAL INSPEC117110N PlEpopT MOOILE / MOOULAR Town of Que&Wxjry Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE- DEPART- I DATE INSP"LaNfREQU NAME: �,an-CWZ- I,OCATION: DATE- 10c; PERMIT I moanx Hom MODULAR ROME FOornNGS FOUNDATION BACKFML FRAMING N/A . YES NO 1. foundation support, pier SPW'Mg per manuf ........................ 2. anchoring per manuf I ............... 3. water line shut off ................... 4. sewer line support a 4 feet ....... S. heating crossover(dblewide) off grd. 6. dryer vented outside x................... 7. skirting ventilated .................... 8. hot water relief valve piping outside 9. deck, porches, steps. railing ........ 10. fiunace/hot water operating ........ 11. garage fire proofing .................. 12. door closers ........................... 13. plumbing fixture ...................... 14. foundation insulation (if appl.)...... 15. smoke detectors ......1. % j7% 16. final electrical ........................ 17. variance required ..................... 18. data plate okay ....................... 19. mobile HUD seal okay .............. Model# Serial # Manufacturer Date of Manufacturer OKAY TO ISSUE C/O YES NO Comments: FINAL INSPECTION REPORT MOBILE / MOOULAR Town of Queensbury Building &Code Enforcement J1 742 Bay Road Queensbury, NY 12804 / (518) 761-8256 ARRIVE: DEPART: - L DATE INSPECTION REQUEST RECEIV NAME: C� LOCATION: 1 2? DATE: - PERMIT MOBILE HOME MODULAa HOME FOOTINGS— FOUNDATION _ BACKFU.L_ FRAMING— N/A YES NO 1. foundation support, Pier spacing / per manuf. ........................ — Y 2. anchoring per manuf. ........ .... 3. water liter shut off .A.�. - & 4. sewer line support 0 4 feet ...3Jli p� 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. furoamAxA water operating ........ — 11. garage fire proofing .................. V/ 12. door closers ........................... _ 13. plumbing fixture ...................... 14. foundation insulation (if appl.).p FA x 7-PN 1S. smoke detectors ....................... 16. final electrical ........................ _ — 17. variance required ..................... 18. data plate okay ....................... 19. mobile HUD seal okay .............. — Model # Serial# Manufacturer Date of Manufacturer OKAY TO ISSUE CIO YES NO RECEIVE JUN - . TOWN OF BUILDING AND CO R Y CO E FILE i Y 11 OWN OF QUEENSBURY PK(O-DING dEi �.RT ENT Based on our limite", exam;nation, 2 compliance with with our comment;shall not be construed as indi(.,�!�'irtg the plans and specifications ';arei`i�,n the compliance with thi,, Budding &es of New York State, 5Ul!�-DiNG & REVIEWED BY t t DATE -7-/2 RECEIVED TOWN 0 "QUEENSBURY BUILDI qG AND CODE 1) / V 13 I y c -I / G1CC Y V j V i 1 � I� 2 ' 13 r �L f 21 ZO t7 by t7 - R ICa- i-i 551 SS` � �� 9 a s 4 L 3 7 4- �` tt ! is { i t 1 ► t ! i a � � � �i r t t � t 1 t I 1 '' i � . • ' r l 8 2— $i ' 8 a 7.9 78 1 77 l 7G i 75 74- f 73 t '7L. 7 1 a 70 ` %9 t s r t ,r . - 83 j 21) 04 F 130 tz9 11b IL 1 t1G. t 1L5 ' tL} tL� +ZZ t 'Zt tzo t t`°t t1$ 1►7 :Vo IN ! i t 41L-L 55� tit +rr1 , 4i� 63 11 172 t i 'Y1 JD