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2005-613 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: P20050613 Date Issued: Tuesday, October 18, 2005 This is to certify that work requested to be done as shown by Permit Number P20050613 has been completed. Tax Map Number: 523400-309-009-0002-001-000-0000 Location: 200 LUZERNE Rd Owner: HOMESTEAD VILLAGE L P Applicant: WILLARD BAKER 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 Enforcement 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: P20050613 Application Number: A20050613 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: WILLARD RAKER 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 4294 ROUTE 5 Mobile Home In Park $800.00 Total Value $800.00 CALEDONIA, NY 14423 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2005-613 WILLARD BAKER 50 WINDSONG DRIVE 14 X 70 1985 MOBILE HOME $33.80 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, September 01, 2006 (If a longer period is required,an application for an extension must he made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Quee ury h rsday, September 01, ZOOS SIGNED BY for the Town of Queensbury. Director of Buildin &Co OEnforcement Application for Permit— Mobile Home Town of Queensbury, 742 Bay Roue Oueensbury, 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 In formation Office Use ' l ^�' 1 Name: ,� �`/ �t d � File Permit No. ��w Address: e, Fee Paid CLA1 2 Reviewed By: - --- - ----................. — Phone No. 5-1 Property Owner Information Parcel Information ` Proposed Date of Placement: OCT Name: 5 rJ Property Location: ,S O ,) ` Address: Road,steec,Avcfuk Name of Mobile Home Park: of-\e S (f applicable) 9 \ Phone No. Tax Map Number: / /- Mobile Home nformation Zoning Information Approximate Value of Home: S . Zoning Classification: New Home: Yes No Size of Property: ft.by ft.Replacement Home: Ye � No Existing buildings: r\Y Size of Mobile Home: I L) ft. by 7 b ft. Setbacks: front yard fl. ; rear yard ft. Singlewide: _(� Doublewide: Side yards ft.and ft. Number of Rooms: (exclude baths) Number of Bedrooms: 3 Accessory Building(s): circle Number of Bathrooms: I _ Detached garage: 1 car; 2 car, car circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1 car, 2 , car Storage building: Yes No Foundation Support: Other: TYPE SIB&DEPTH Water Supply: well or municipal Piers x Runners x Is Septic Permit Required? Yes or No Slab s Further information requested on the reverse side of this sheet Name of Installer or Mobile Home Dealer. -Z S Address: Phone No. —0 7 0'7S Complete information below found on a"plate"or"sticker"which is affixed to the mobile home. 1. Insignia serial number. 5 _ 2. Name of manufacturer 3. Plan Approval Number: 4. Model or Component Designation: (New Home Ohl19 5. Date of Manufacture: 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. t Signature:�A �Pll owner,owner's agent,architect,contractor Special Conditions of Permit By Form: 11/19/1999sh Code Enforcement Officer FINAL INSPECTION REPO f MOBILE / MODULAR Town of Queensbury ��11 Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: DEPART INSP:� DATE INSP�E�C"^TION REQUEST RECEIVED: IO I7 LZ NAME: lar L - " key 7 �-7' C`r'l icr— Lo ATION: 5y ,•�dSa .c� b.��lSo:, DATE: i0 I l�l cS S� PERMIT# 5--6/3 MOBILE HOME MODULAR HOME FOOTINGS FOUNDATION BACI4TLL FRAMING N/A YES O 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, potches, steps, railing ........ _ — ,10. fiunace/hot water operating ........ _ 11. garage fire proofing ................. — — VIumbing oor closers ........................... fixture 14, foundation insulation (if appl.)...... ✓ _ 15. smoke detectors . 16. final electrical .. 1. .6.. ... _ 17. variance required ..................... 18. data plate okay ....................... _ — — 19. mobile HUD seal okay .......f...... Model Manufacturer Date of Manufacturer OKAY TO ISSUE C/O YES NO Comments: ,��(Z, LIB tA44J—WA` FINAL INSPECTION REPORT MOBILE / MODULAR Town of Queensbury Building & Code Enforcement •- 742 Bay Road / Queensbury, NY 12804 (518) 761-8256 ARRIVE: DEPART: f C,39INSP: DATE INSPECTION REQUEST RECEIVED: NAME: LOCATION: V�►. DATE: 'h3oPERMIT# �6 MOBILE HOME MODULAR HOME FOOTINGS FOUNDATION BACKFILL FRAMING N/A YES O 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, pouches, 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 - 17. variance required ..................... — — 18. data plate okay ....................... _ 19. mobile HUD seal okay .............. — Model# 4 J) 2XM25 Serial#-Z Manufacturer 1ZC5 � Date of Manufacturer OKAY TO ISSUE C/O YES "Y�NO Rfb<3HMA%4t-ASI�� 6 Comments: 9M-4 Qee-A!- _�z�ai�Sv -Z54.Pd aa� L PfSSJI i r (40 13 wir- f z� 4 TOWN OF QUEENSBURY BUILDING & OD S DEPT. 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