2004-920 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: P20040920 Date Issued: Tuesday, November 30, 2004
This is to certify that work requested to be done as shown by Permit Number P20040920
has been completed.
Tax Map Number: 523400-309-009-0002-001-000-0000
Location: 75 ALP ejAVENUE.
Owner: HOMESTEAD VILLAGE L P
Applicant: JASON J. CARPENTER
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: P20040920 Application Number: A20040920
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: JASON J. CARPENTER
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 $5,000.00
Total Value $5,000.00
CALEDONIA,NY 14423
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2004-920 JASON CARPENTER
980 SQ FT MOBILE HOME (1983)
$33.80 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, November 30, 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 Town o u sbury; ue y ember 30, 2004 _
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
11/18/2004 THU 08:51 FAX 2002/002
Name of Installer or Mobile Home Dealer: kECEIVED
Address: ` NOV 2 3 2004
Phone No. TO BUILDING AND CODE
Complete information below found on a`date"or"sticker"which is affixed to the mobile home.
I. Insignia serial number
2. Name of manufacturcr
3. Plan Approval Number: _
4. Model or Component Designation:
(New Home Ole I)
5 Da'te ofmruft ire:.
- A•FFID•AVII
� - F
a
eta -
Couuty of waum
3
I swear that to the best of my knowledge and beliefthe statements i
contained in this application,together with the plans and specifications i
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 ORDINANCI,'and all other laws pertaining to the proposed work
shall be complied with,whether specifie&or not',and that such work is
authorized by the owner-
Signature:
er,owaa'' eat: ntracror � ,
Special Cotions of Permit
Fwm: 11119r19M Code Enforc=ent Officer
11/18/2004 THti 08:51 FAX [a001/002
Application for,Permit- Mobile Home Rece
Town of Queensbwty, 742 BayRoacZ Queensbury,Nf 12804 (S18) 761-8256 VEFD
Nov 2
A building permit must be ottained before placement of mobile home on parcel. No kspections will be mad ?004
until a valid building permit has been issued. TOWN OF QN�FNSB(1
AppliotmtInformation pE T
Offtce Use _
Name: io) � 1/l File Permit No. Ll 9 a -
Address: 74
1~ee Fad
oN�caeqcz Uvmaro, Reviewedy. ... _
Phone No. twin:74fii tat — ��
.Property Owner brfarmation Parcellnformadon o f
Name: -Gp1f G Proposed of Placement: 01Y S
Property Location:7YAla b.c, Auf-
Address: 7 6a2 f ve saea,Avg
`yL Name of Mobile Home Park: �d K
-Phone No. Tax Map Nu mr:
:. .. -Mobile Home Information.::_.__:—. r__. .9i?Wqg.It.former
App Yalnc of Home:S� ..
Zoning Classification:
New Home: Yes No
< Size of Property: ,.--.—ft by fL
Replacement dome: Yes No'
Existing buildings:
Size of Mobile Home: . & by -70&
Setbacks: front.yard L; rear yard it.
Singlewide: _ Doublewide: Side yards ft-and &
Number of Rooms: (exclude baths)
Number of Bedrooms: a+ Accessory Buildutg(s): circle
Number of Barhmoms:
Detached garage: 1 car, 2 car, car
circle: Gras Fireplace/Woodst.ove/Wood Fireplace Attached garage: 1 car; Z car, car
Storage building: Yes No
Foundation Support: Other:
?n'E ST &DIY'1H Water Supply- well or municipal
Piers i
Pl m= x Is Septic Permit Required? Yes or No
Slab x
Further information requested on the reverse side of this sheet
F I�i4L INSPECTION REPORT
®BILE / MODULAR
Town of Queensbury
Building & Code Enforcement r
742 Bay Road
Queensbury, NY 12804
M (518) 761-8256
ARRIVE: DEPART/.-� � INS (�
y
DATE INS TION REQUEST REC IVED:
NAME:
LOCH
Q �
DATE: 6 GG ERMIT#D
MOl ILF. HOME ODULAR HOME
FOOTINGS FOUNDATION BACK FILL FRAMING
N/A YES NO
1. foundation support, pier spacing
per manuf. ........................
2. anchoring per manuf. ...............
�3. water line shut,off .................... _ — _—
'V sewer line support ®4 feet ....... _
5. heating crossover (dblewide) off — —
6. dryer vented outside ............... ..... _
skirting ventilated ................ ...
77.. _ —
8. hot water relief valve piping tside —
9. deck, porches, steps, railing ........ _ —
10 furnace/hot water operatin ........
11. garage fire proofing ...... ........... — — —
12. door closers ............ ........... — — —
13. plumbing fixture ...... ............... — —
14, foundation insulatio (if appl.)...... —
5 smoke detectors .. ... . .... _
6 final electrical
17. variance requir ........ ............
18. data plate oka ....................... —
19. mobile HUD seal okay ..............
Model # Serial#
Manufactur r
Date of anufacturer
OKAY TO ISSUE C/O YES NO
Comments:
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804!
(518) 761-82 \
ARRIVE: DEPART: '�INSP.
DATE INSPECTION REQUEST RECEIVED:
NAME: C -Fee
LOCATION: 7 5- 4)e-- ,
DATE: 1 i PERMIT#
MOBILE HOME V MODULAR HOME
FOOTINGS FOUNDATION BACKFII-L 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 .................... _
. hot water relief valve piping outside — —
deck, porches, steps, railing ........
0. 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:
Y
FILIAL INSPECTION REPORT
MOBILE / MOOULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART: INSP:
DATE INSPECTION REQUEST RECEIVED:
NAME:
LOCATION: 77s- Ala, Ode_
DATE: 1 j 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. ✓f _
6. dryer vented outside ....................... I/ —
7. skirting ventilated ....................
8. hot water relief valve piping outside ✓ — _
9. deck, porches, steps, railing ........
10. furnace/hot water operating ........ I/
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 # V Serial # 10 J6
Manufacturer 1t0"-L 10"Z—
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments: J ��`
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