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2004-063 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040063 Application Number: A20040063 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: TANTA DORN 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 $22,000.00 4294 ROUTE 5 Total Value $22,000.00 CALEDONIA, NY 14423 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2004-0063 LOT 80 ALPINE AVENUE 980 SQ FT MOBILE HOME $W00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, March 01, 2005 (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 thwXwn of Q ensbury; onday,March 01, 2004 SIGNED Y P J for the Town of Queensbury. Director of Bu ding&Skode.Enforcement Application for Permit— Mobile Home Town of Queensbury, 742 Bay Road 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 Office Use/ Name-7 e VFile Permit No. Address: 10 Fee Paid Y - . Reviewed B,y: . ,`ECEI Phone No. FEa 7 2004 Property Owner In ormation Parcel Inform OF QUEENSBURy P �' .fNUIG A CODE Proposed Date of Placement`. Name: f"e-- Property Location: 4 _ Address: . lr. �J /� Roo Street,Avenue �cc%- 'u S 4 /�, �i Name of Mobile.Home Park: YV1 �t`�`� '_ Wapplicable) Phone No. (S( — Tax Map Number: Mobile Home Information Zoning Information Approximate Value of Home: $ 2, p Zoning Classification: New Home: Yes Size.of Property: ft.by ft. Replacement Home: es No Existing buildings: Size of Mobile Home, ft. by 7O .ft.. Setbacks: front yard ft. ; rear yard ft. Singlewide: Doublewide: Side yards ft.and ft. Number of Rooms: (exclude baths). Number of Bedrooms: - Accessory Building(s): circle Number of Bathrooms: <24— 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 x Runners X Slab x Is Septic Permit Required? Yes or No Further information requested on the reverse side of this sheet Name of Installer or Mobile Home Dealer: \10J u\q— l n 66; le gam Flqm Address: Phone No. Complete information below found on a"plate"or"sticker"which is affixed to the mobile home. 1. Insignia serial number. J �a"3 el[o 76 r-7 5 & ; a 2. Name of manufacturer. RCdyY1Ck6 C 3. Plan Approval Number: 4. Model or Component Designation: (New Home OAE19 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. Signature: owner,owner's agent,architect,contractor Special Conditions of Permit By. Fmn: 11/19l1999sh Code Enforcement Officer FILIAL INSPECTION REPORT MOBILE. / MODULAR Town of Queensbury Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: DEPART: - INSP.- DATE INSPECTION REQUEST RECEIVED: NAME: LOCATION: DATE:�-3 a PERMIT# 0 1-1-063 M®BILE HOME V 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 ..a................... 70.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.)...... — smoke detectors 1 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 Comments: FINAL INSPECTION REPORT MOBILE / MOOLILAR Town of Queensbury Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: DEPART -^� SP: - DATE INSPECTION REQUEST RECEIVED: NAME: vll, Cam- LOCATION: , DATE: PERMIT# 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 ..ti................... 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 # �3�J dL Serial # Manufacturer A d k� -1 Date of Manufacturer 3. OKAY TO ISSUE C/O YES NO �Iomflko t a� l?G n'T 1� Sihw Mary rments: 8V QUEENSBUf�Y ,4 vt( . .�1• `1 f3UIl DING AnJD CODE _ fn Cre ; to �. � �:f ; t� W• w W Cam. 1N ry; N ;N vi 7 r. ;- c VI' t _ ,Qom.:,^ .,2 'L✓ t a.:r -10 / i�:-a nr'lt 1 r LJ. -•� i C SV'+3•.'3 t t; i �� \�a L �'f t T V.�rJ. ��J �W~ .:S:•O V, A ` %} �S t } J S.rtV/y_��C j .F• ?. z .- .. ` :, �d�, Ki �4♦ �t�,.ii3 Atf� Nf riy� .. �v -��t � i r� {Yer��tZ�r `� r� Q . t4;e 1r•�r�`ro; -ra.. i`'�x _'<aTJ i r t ' r ,� !�. r ,s, f �7� (,/ T..lr �L�f'as 7 1 •r,L/��7 S {��f`. I t Ur 11 n t f I f