2004-414 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: P20040414 Date Issued: Monday, August 23, 2004
This is to certify that work requested to be done as shown by Permit Number P20040414
has been completed.
Tax Map Number: 523400-309-009-0002-001-000-0000
Location: 137 Ad Aondack Road
Owner: HOMESTEAD VILLAGE L P
Applicant: KENNETH R HARRIS SR
This structure may be occupied as a:
By Order of Town Board
Mobile Home In Park TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P200404414 Application Number: A20040414
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: KF,NNF,TH R HARRTS SR
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 $20,000.00
Total Value $20,000.00
CALEDONIA, NY 14423
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2004-414 KENNETH R.,HARRIS SR
1120 SQ FT MOBILE HOME
$42.20 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, July 07, 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 the To ueens}yry; d esday, July 07, 2004
SIGNED BY ,' ! for the Town of Queensbury.
Director of Building&Code forcement
Application for Permit— Mobile Home
Town of Queensbwy, 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 In
formation Office Use
Name: rf ��� �1 �� Y l'r�S File Permit No.
Address: p d D X 78 Fee Paid 2.
___.-----Reviewed By: JUN r
Phone No. 5'/*- (o(aY --29 9 WNOFQ 04
0 Parcel Information ANC� URY
Property Owner Information f
t Proposed Date of Placement:
Name: � ���� e e-,I-,�
Property Location: i3 7 dacd.t'�(�
Address: 70.z-- RoacL Stteet,Avemie
Name of Mobile Home Park: /yb/W es Ae,a
_.. Cfapplieable)
.Phone No. - & -R) � . _
Tax Map Number:
Mobile.Home Information.._ --.-... _: Zoning-It formation
Approximate Value of Homer S
Zoning Classification:
New Home: Yes No 6 S "-
�'�- Size of Property: ft.by ft.
Replacement Home: (Ye;.) , No
,L/ Existing buildings:
Size of Mobile Home: ft. by ft.
Setbacks: front yard fh; rear yard fL
Singlewide: U/- Doublewide: Side yards $ 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/Woodstove/Wood Fireplace Attached garage: 1 car; 2 car, car
Storage building: Yes No
Foundation Support: Other:
TYPPE iers $t �'SIZE&DEPTH Water Supply: well o-.�,uninP_s'� h
Slab ers r Is Septic Permit Required? Yes .or No
Further information requested on the reverse side of this sheet
r _
Name of Installer or Mobile Home Dealerl�r S ��
Address: �'(,� U 0-n e-Q s e r? T, /Q
Phone No- 7 9_ - :3 i 7
,41 ' - ---.
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
L . Insignia serial number. 0 7 ;CBS
2. ;. Name of manufacturer /3 aG.ri
3. Plan Approval Number:
4. Model or Component Designation:
(New Home O.AE19
Date of Manu& 9 rr'
_.. .. AFFIDAVI.T_- -
_ Town of Queensbury -- = -
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 BUII,DING 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
E
Form: 11/19Ir999sh Code Enforcement.Officer
Queensbury Building & Code Enforcement - Residential Final Inspection , ;v
Office No.(518)761-8256 Arrive: am/p D part: am/pm
Date Inspection request received: Inspector's Initials: 'o
NAME: 0 PERMIT#: 110� ' -
LOCATION: — Icj. DATE:
TYPE OF STRUCTURE: Z_ (I A
nts
Y N • N/A
Chimney Ht./"B"Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumb Vent throw h roof minimum 6"
Roof Complete/Exterior Finish Complete
Guard 30 in.or more @ stairs,decks,patios
Guard at stairwell at 34 in. or more �^ A N �bb l �L
Guard at deck,porches 36 in. or more AJ
�,
Exterior Finish Complete Z �10 � /ham IA-)S f �C
Interior/Exterior Railings 34 in.to 38 in.
Platform at all exterior doors
Interior Handrails stairs 2 or more risers
Enclosed Stairs Sheetrock Underside minimum %"
Gypsum
Grade away from foundation 6 in. with 10 ft. Alm
Handrail Termination at Newell Post or Wall / f' l
6 inch clearance to sill plate ,t 1C��� /L���C
Gas Valve shut-off exposed/regulator 18"above grade /V l`�
Gas Furnace shut-off within 30 ft. or within line of site
Oil Furnace shut-off at entrance to furnace area
Fumace/Hot Water Heater operating
Low water shut-off boiler
Relief Valves installed/Heat Trap/Water Temp, 110
Interior privacy/trim/doors/main entrance 36 in.
Bathroom/Kitchen watertight
Safet Iazin /Window in stairwells safety glazing
Interior Smoke Detectors:
Every level: / Every Bedroom:
Outside every bedroom area:
Inter Connected: — / Battery backup:
Carbon Monoxide Detector
Bathroom Fans, if no window
Plumbing fixtures
Foundation insulation
Floor truss, draft stopping finished basement 1,000 sf
Emergency egress below grRde
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing/'/4 hour fire door/door closer
Duct work Sealed properly
Gas Logs in Sealed or Glass Enclosure
Attic access 30 in.x 22 in.x 30 in.(ht.)In accessible area
Crawl Spaces IS"x 24"access, 1 s . ft.-150 s . ft. vents
Building No./Address visible from road
Final Electrical
Site Plan /Variance required
Final Survey Plot Plan
As Built Septic System/Sewer Dept. Inspection Sticker
Flood Plain Certification, if required
Oka to issue C/C or C/O [Temporary/Permanent
L:\PamW\Buildinp,&Codes\Inspection Forms\Res, Final Insp. form 2.docLast printed 2/12/04
FINAL INSPECTION REPORT
MOBILE. / MOOULAR .
Town' of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
3' �
' ARRIVE: DEPART: '
DATE INSPECTION REQUEST RECEIVED:
NAME
LOCATION: I rr��J f I
OQ
DATE: 0 O 1- i QO PERMIT.# U I
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. _� y
6. dryer vented outside ..1................... _ _ —
7. skirting ventilated .................... _ _
8. hot water relief valve piping outside — —
9. deck, porches, steps, railing ........ _
10. furnace/hot water operating — .r —
11. garage fire proofing ................
12. door closers ...........................
13. plumbing fixture ...................... `/ —
14. foundation insulation (if appl.)...... �f _
15. smoke detectors 11
^' \
16. final electrical Z .
17. variance requir .....................
18. data plate okay ....................... —
19. mobile HUD seal okay ..............
Model # pSerial # c �o
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES I� NO _
QoI-ji,wl—
mments:
K A-r:4 ski RT k (4 I�6(
Dow"
Dow Pao c I kK j 2 0 i:qk U—Ak
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FINAL INSIPEC ION REPORT
MOBILE / MOOLILAR
Town of Queensbury )
Building &Code Enforcement ✓
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
J ,-
ARRIVE: DEPART: NSP:
DATE INSPECTION REQUEST RECEIVED:
NAME: \\ \
LOCATION: Od U ) S
DATE: PERMIT# `' r
MOBILE H0M2 V MODLJI R 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, potches, 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 # Ago Serial #
Manufacturer �r`�
Date of Manufacturer b ?/
OKAY TO YES NO
Comments:
Y
'.' NAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building &Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8 � j
rL
ARRIVE: DEPART: ' INSP:
DATE INSPECTION RE UEST RECEIVED-
NAME; AiPurt S
LOCATION:
DATE:. PERMIT# U
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION BACKFILL FRAMING
X/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:
FINAL INSPECTION REPORT
MOBILE / MOOULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: .DEPART:� NSP: D
S�
t
DATE INSPECTI011REQUEST REC D:
NAME: I' (n.�i2Q�4 �a►�.,�jiS
LOCATION: TJ 7
DATE: 9 PERMIT# 1
MOBILE HONi MODULAR HOME
FOOTINGS _ FOUNDATION _ BACKF LL_ 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, potches, 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
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments:
FINAL, INSPECTION REPORT
MOBILE / MOOULAR /
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804f
(518) 761.8256 , `/
ARRIVE: DEPART: ' e INSP: ��i�
DATE INSPECTION REQUEST RECEIVED:
NAME: C4U)' k&41,e ' JYI-S
LOCATIOf5 /'"� I �� (G�cI 1'C61►oC
DATE: D o PERMIT# ``
Its
M II. HOMS MODM AR HOME
FOOTINGS FOUNDATION BACKFML 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 ........................
17. variance required ..................... — —
18. data plate okay .......................
19. mobile HUD seal okay ..............
Model # Serial#
Manufacturer
Date of ufacturer
i2 C — 5
OKAY TO ISSUE C/O YES NO
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