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2003-702 TOWN OF QUEENSBURY 742 Bay Road,Queensbm7,NY 12804-5902 (518)761-8201 Community Development ' Building&Codes (518)761.8256 OF O�CC �t1PANCY CEIRTIFICITE Permit Number: P20030702 Date Issued: Monday,November 24,2003 This is to certify that work requested to be done as shown by Permit Number P20030702 has been completed, Tax Map Number: 523400.309.009.0002.001.000.0000 Location: 105 ALPINE AVENUE Owner: HOMESTEAD VILLAGE L P Applicant: DALE AGARD This structure may be occupied as a: By Otdet of Town.Boatd Mobile Home In Park TOWN of QUEENSBURY r Nectot 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: P20030702 Application Number: A20030702 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: DATR AGARD 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 $20,000.00 4294 ROUTE 5 Total Value $20,000.00 CALEDONIA, NY 14423 Contractor or Builder's Name Address Electrical Inspection Agency Plans&Specifications 2003-702 105 ALPINE AVENUE DALE AGARD 1456 SQ FT 2000 MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS $62.36 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, September 03,2004 ([f a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) ,0--- er Dated at th Town Qu e s, sday, September 03,2003 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit-- Mobile Home Town of Queensbury, 742 Bay Road, Queensbury, NY 12804 (518) 761-8256 A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a valid building permit has been issued. Applicant Information Office Use Name: �n'1� 7 -*-� U Ze c r-- File Permit No.0�3-7-A Address: - Fee Paid AUG, 7*0 zoo3 1 �_- Reviewed By: ��/1f��� ti�lvS_ppy� - ................ » Phone No. �jcac� J CO r Property Owner Information Parcel Information Name: 14V e Proposed Date of Placement: ;-�-,�� Property Location: -, Je A2 Address: Road,.Stieet,Avenue °_G Name of Mobile Home P rk:(ifapPlicabte)%�(v�,'Le � irlurt� c3""� Phone No. `' �' f� la � p r~ '� SS.S Tax Map Number: ��o2�7 9 Mobile Home Information Zoning Information Approximate Value of Home:$ ,- adr> Zoning Classification: New Home: Yes No ill�j Size of Property: ft.by ft. Replacement Home:' Yes No Existing buildings: Size of Mobile Home: ft. by ft. ` Setbacks: ,,front yard fL; rear yard ft. Singlewide: Doublewide: L.I-111, .Side yards ft.and ft. a Number of Rooms: (exclude baths) j 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 municipa Piers x Runners x is Septic Permit Required? Yes or Slab x Further information requested on the reverse side of this sheet MOO, Name of Installer or Mobile Home Dealer. O Address: _ �4,_ L Phone No. - / Complete information below found on a"plate"or"sticker"which is affixed to the mobile home. 1. Insignia serial number. 2. Name of manufacturer. __ G C R 3. Plan Approval Number: 4. Model or Component Designation: (New Home ONLY) t 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: Il(�r^��1)r � ��--- h owner,owner's agent,architect,contractor Special Conditions of Permit L BY Form: 11n9/1999sh Code Enforcement Officer P�N�►L �1'lI�PECTt®N �E�ORT -rc)wn of C)usmansbur-y Building 8k Cede Enforc4amatnt 742 El ay Road Queensbury, NY l aB04 (518) 761-8256 AR.RI'"'�J'p: Z�EIPAR'T; �� � r �' ''' � ,•-f LATE 1NSP"�C'�ICtN R.P'K�LTI�ST Ix.F+CEI'V�Z�_ �►A� "" - PER "tr1IT # Al10►�ILE: �'t]►A�3� 1�+Ii?I]iLTLA�i. Ht'!ML ��C�"INGS FC7L7N,UA'I`IC7N EACKFIr_T _ FRAMING 1�FlA YES NQ 1. foundation support pier spacing per rrUanuf- ---- -------------------- 2. anchoring per niarsu� --------------- 3. water line shut ciff ------ ------ ---- -- - - 4. sewer line support 4 feet --_---_ 5. heating crossover off grd- 6. dryer vented ©utside ---------------------- 7. - skirting ventilated -------------------- 8_ hot water relief valve piping outside 9_ deck, pot-clies, steps, railing - -- ----- 10. furrnacelhot water operating -------- IJL. garage fire proofing -------- ---- ------ 12_ door closers ------- - ---- -- ------------ - 13. plumbing fixture ------------------- --- 14- foundation insulation a(i f appl-')------ IS- smoke d.et+ectors ------ ---- ------ ------- 16. final electarical ------------------------ 1'7- variance required. -- ------- ----- -- ----- :is- data pla w okay ....................... 19. mobile HL71J seal c.>kay ------------ - Seria 1. # Z�a.te of Manufacturer _�',� C.aKA`Y T+rp lSSL3E C!Q YES N+C7►. Comments: ii�+l�l1E�� AM /' F*AOVC=PZ=IRJ L-/t:LR Torn of CQueonsbury 8ullding 8; Cade Enforcomont 742 Bay Road G;u nst>ur-y, -NY 12804 � (518) 761-8256 ARRIVE: � DEPART: t IN j- �- DATE -INSPECTICJN I2EQLTE.'S RECEIVED: NAME: ' DATE: � ,� r � ��► FERMI'F' � '' � _ ���H�,E Y-IC'��� - �i'�►H�LTL�►� HClME FC}C�TNGS -Fc3UNDA'TI©i�I BA�'EG~L7-7 FRAMII�TG a NIF.1"� YES NC3 1 . fc�urtclation suppc�x-t, pier spacing _ _ /'� pea rnarlAif. ---- -------------------- 2. anch©ring per rnanuf_ --------------- 3- water line shutoff ------------------- - 4. so�wer line suppeart (90 4 Few-,t -._ -- 5. heating crcass+c�ver (dblewide) c►ff grd_ _ 6_ dryer vented outside ---------------------- 7. - skirting ventilated -------------------- 8. hot water relief valve piping outside 9- deck, pot ches, steps, railing ----- - 10. furnacelh<A water ........ 11. garage fire prcmcfing ------- - ---- ------ 12. der cI©sers ----- - --------- -- ---------- " 13. plurrabing fixture ------------------- --- 14. foiandatiorn irssulati©n (if appl.)-:---- 15. sx* cylte cletectcrrs ----------------------- 1.6. final electrical ........................ 17_ variance required _____________________ 0100, 18_ data plate okay ............ ........... 19. mobile I-I-LJD seal cakay ----- -------- model # r -- serial. # L3ate of Mans�facturer '��'-'��,- —per - wing g '4�sitt;A j NO A q, in � t. 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