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2005-755 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20050755 Date Issued: Tuesday, October 25, 2005 This is to certify that work requested to be done as shown by Permit Number P20050755 has been completed. Tax Map Number: 523400-309-009-0002-001-000-0000 Location: 169 ELMHURST DRIVE Owner: HOMESTEAD VILLAGE L P Applicant: PHILIP & MICHELLE WILSON 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 JW 00t 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: P20050755 Application Number: A20050755 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: pH1T.1p&M1('HF.T,T,E WH,SON 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 $1,500.00 4294 ROUTE 5 Total Value $1,500.00 CALEDONIA, NY 14423 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2005-755 169 Elmhurst Homestead Mobile Home Park 14' X 52' (1978 MOBILE HOME) $0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, October 04, 2006 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the T wn of een ry , ctober 04, 2005 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit— Mobile Home - Town of Queensbwy, 742 Bay Road, Queensbury, NY 12804 (518) 761-8256 v (� A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a valid building permit has been issued. Applicant Inform ion � >D Office Use Name: i Filet No. Address: o Fee Paid 0 Reviewed ------ By: ��3 _ - LL Phone No. �r'�; `01 l (40 Property Owner Information Parcel Information t L Proposed Date of Placement: t� i Name: ' I la�t 1 lQ q Property Location: -G Address: tl�P r YlQ QO' Road,suet, , Name of Mobile Home Park: �IC�MSL�IsI 1c�Q rif applicaNe) _ c ; Phone No. Tax Map Number: N' _ Mobile.Home Information Zoning Information: . -. _ Approximate Value of Homer$ -- Zoning Classification: New Home: Yes No Size of Property ft.by I Replacement Home: No offi Existing buildings: Size of Mobile Home: ft. by Setbacks: front yard &; rear yard ft. SingIewide: _ Doublewide: Side yards &and ft. Number of Rooms: (exclude baths) �t 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 Fitrther 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. I. Insignia serial number -:5 -8-70-35- 2. Name of manufacturer:� ���'�n j ryw-S 3. Plan Approval Number: b.P.A .P,M 9, 4. Model or Component Designation: (New Home ONZ19 5_ Date of ManufaefWt.' . 0-` 117 _ AFFIDAVIT - 'Town of ` - e ofN Y6rk j 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 1 the described premises and that all provisions of the BUILDING CODE,the 1 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. owner,own 's agent,architect,conrtracWr Special Conditions of Permit Form: 11r1911999sh Code Enforcement Officer f i IA i 4 yJ 1 \ i i f ([ � Q 1 "t R C F �o c FINAL INSPECTION REPORT MO®ILE / MODULAR Town of Queensbury j Building &Cade Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-82.56 t ARRIVE: DEPART: t P: DATE INSPECTION REQUEST RECEIVED: -------------------- NAME: ,i I LOCATION: R , DATE: PERMIT~ ll[OBILE HOME��Mowa HOUR FOOTINGS v FOUNDATION — BACKFI L_ FRAMING' NIA YES INO I. foundation support, pier spacing ° per manuf. ........................ 2. anchoring per ma puf. ............... 3. water line shut off ................... 4. sewer line support 0 4 feet ....... S. heating crossover(dblewide) off grd. 6. dryer vented outside ..:................... 7. skirting ventilated .................... 8. hot water relief valve piping outside — — 9. deck, poaches, 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# Se — Manufacturer C�t, tL*J Ker% > 13ate of Manufacturer OKAY TO ISSUE CIO NO Comments: FINAL INSPECTION REPORT MOBILE / MODULAR Town of Queensbury Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ja ARRIVE:°-')DEPART: NS DATE INSPECTION REQUEST RECEIV D: NAME: LOCATION: DATE: 9 '- ��' PERMIT# 2u>5 7 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. f imace/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 # Serial# Manufacturer Date of Manufacturer OKAY TO ISSUE C/O YES NO Comments: e /r NAL INI#PEC+ION REPORT MOBILE / MODULAR Town of Queensbury Building &Code Enforcement y 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: DEPART: INS DATE INSPECTION REQUEST RECEIVE NAME: U i "� �' S o LOCATION: DATE: �� l) PE T# MOBILE HO OIDULAft H FOOTINGS : FOUNDATION ^ BACKFILL_ FRAMING NIA 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. funnace/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 # Serial# Manufacturer C1Aixt 1� Date of Manufacturer ^Z � OKAY TOE YES NO Comments: \_T o c '- u 2CU C�fl � \' � y � M � �_- �� � � � � � � L� � c� (Yl �(� ISP r5_ TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 518-761-8201 September 23, 2005 Manager- Homestead Mobile Home Park 200 Luzerne Road Queensbury, NY 12804 RE: Philip and Michelle Wilson Year 1978 Mobile Home Serial Number: F-58-8-7035-2787 Dear Manager: Inspection of the above-mentioned mobile home meets New York State standards for placement of such home in the Warren County, NY region and to be placed within your park at 200 Luzerne Road. However, due to the lot size and configuration of lot 23 Windsong Drive, the mobile home (14 ft. by Set'j yvill not meet zoning setback requirements. The mobile home rKu. e moved to another lot within your park. The mobile home will meet such setbacks on lot 169 A t* Street. E--t-Mt-�S The current permit applied for on lot 23 Windsong Drive (BP 2005-755) may be applied to lot 169 Adirondack Street. The only additional requirement . for the permit is an accurate plot plan depicting the exact placement of the home on the lot. The applicant, Philip and Michelle Wilson understand this and will comply to the Town of Queensbury's requirements for a building permit. Thank you. Sing ely, John O'Brien Code Enforcement Officer JOB/sh "HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE" SETTLED 1763