2004-087 i
a
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: P26040087 Date Issued: Friday, April 30, 2004
This is to certify that work requested to be done as shown by Permit Number P20040087
has been completed.
Tax Map Number: 523400-309-005-000 1-00 1-000-0000
Location: 22 PINE CONE (DRIVE
Owner: D&G MANAGEMENT LLC
Applicant: RITA M.QUARTIERS
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: P20040087 Application Number: A20040087
Tax Map No: 523400-309-005-0001-001-000-0000
Permission is hereby granted to: RTTA M OTIARTIERS
For property located at: 158 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: D&G MANAGEMENT LLC
PO BOX 224 Mobile Home In Park $40,000.00
Total Value $40,000.00
GLENS FALLS, NY 12801
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-087
1560 SQ FT MOBILE HOME
$68.60 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,March 25, 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 wn Queen r , March 25, 2004
/ for the Town of Queensbury.
SIGNED BY Q ry
Director of Building&Code Enforcement
Application for Permit— Mobile Home
Town of Queensbw y, 742 Bay Roast Queensbwy, NY 12804 (518) 761-8256
A building permit must be obtained before placement of mobile home on parcel. No inspections
P P e
until a valid building permit has been issued.
Applicant In
formation MA R 1 2004
r Office Use TOWN
QUF6
NSBURY
Name: / (,tCLI �i�►''S File Permit No NGiVD BODE
Address: 2 2 J �1/!� L �.�� Fee Paid
Reviewed By: f� -
Phone No. 111information
Property Owner Information Parc
- 7)r
Proposed Date of Placemern: Lj ` O7Name: Dph j:-- /
�^ Property Location: �J L
Address: R /Ave�ee
Name of Mobile Home Park
r a l cable
PP
-Phond No
— -. Tax Map Number: /
Mobile Home In
formaiipn -.._._..._-..i : ._. --- Zoning.Ixrformation:..,
Approximate Value of Home: )—,
Zoning CIassification:
, �New Home: - Yes .
Replacement Home: es No
S(� Size of Property: //U ft.by ft.
Existing buildings: lY oyC_
Size of Mobile Home: A6—ii:: by.�tft.
Setbacks: front yard fb; rear yard30 ft. -
Singlewide: �— Doublewide: X , i S Side yards 1_ft.and /D 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 r, car
Storage buildin Yes o
Foundation Support: Other: r)
TYPE SIZE&DEPTH Water Supply: well or municipal
Piers x
Runners x Is Septic Permit Required? Yes or No
Slab x
Further information requested on the reverse side of this sheet COO-
Name of Installer or Mobile Home Dealer. a4id
Address:
Phone No. 293 '019
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
1. Insignia serial number. 1-n )�-o LIZ 70 P,16
2. Name of manufacturer. m&7h
3. Plan Approval Number:
4. Model or Component Designation: _
(New Home OAEI)
5_ Date of Manufacture:
AFFIDAVIT-
Town of --
nsbury ._ . _.. .. .. ----.-.... �...•. -..--StateafNeaFYoric
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-
Form: 111191m9sh Code Enforcement Officer
FINIAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement o
742 Bay Road
Queensbury, NY 12804
(518):761-8256
ARRIVE: DEPART: I
DATE INSPE,=qN REQUEST RECEIVE
NAME:
y \\
LOCATION:
DATE: PERMIT# D LI Cl
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. 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 Manufacturer
OKAY TO ISSUE C/O YES NO
Comments: -e CDS2 ��l
�� `L�
FINAL INSPECTION REPORT
MOBILE: / MOOULAA.. .
Town of Queensbury
Building & Code Enforcement n
742.Bay Road
Queensbury, NY 12804
(518):761-8256 G
ARRIVE: DEPART::
DATE INSPECTION REQUEST RE IV
NAME: G 1
LOCATION: f'
DATE: PERMIT#
MOBILE HOME MODULAR HOME
FOOTINGS _ FOUNDATION _ .BACKFILL_ FRAMING
N/A YES NO
1. foundation support, pier spacing
per manuf. ........................
2. anchoring per inanuf. _ Y —
3. water line shut off ............\\....... _
4. sewer line support @ 4 feet }I...... _ —
5. heating crossover (dblewide)'off grd. —
6. dryer vented outside ..;...................
7. skirting ventilated ....................
8. hot water relief valve piping outside _ —
9. d rches, steps, railing ........ — —
fi ce of water operating ... b��J
11. garage fire proofing ................ _
12. door closers ......... ................. —
13. plumbing fixture ... —
14. foundation insulation (if appl.)...... -
15 woke deter s. ..... �—/
6. a ectrical �� i.F! .••..
requued ..................... —
18. data plate okay ....::.................
19. mobile HUD seal okay .............. _
Model# o�� Serial #
Manufacturer
Date of Manufacturer •-KA
OKAY TO ISSUE C/O YES. NO
Comments:
U L�ire y c,
Foundation Inspection Deport
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/p� / Depart: am/pm
742 Bay Rd., Queensbuiy,NY 12804 Inspector's Initials: sL --
NAME: PERMIT#: <:)ZO C ` U
1
LOCATION: INSPECT ON: a
TYPE OF STRUC RE: G
Comments
Y N N/A
Footings PR V
Piers o ithic lab 14ff9*UA-e- (—�5;t� 7
M 6l S
enforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site.
Foundation/Wallpour
Reinforcement in Place
Foundation Dampproofing
Foundation/Waterproofing
Type of Dampproofng/Waterproofing
Footing Drain Daylight or Sump.
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
LASueHemingway\Bui]ding.Codes.Inspection.FORMS\Foundation Inspection Report.doc January 28,2003
FROM�-NORTHW_INDS MOBILE PARK FAX NO. :7925838
Mar. 02 2004 08:45AM P1
3o .
N
-- ,SOO,
MAR ; 7'04
TO N OF 'UE"c;VSBU
TOWN OF UEENSBURY BUILDING DEPARTMENT NOTICE LD��G A,�pA ��
co on with
limited examination ANCHORING OF MOBILE}���
com liance with our comments shah
not construed as indicating the
plan and specifications are m full
FRAME IS REQUIRED PER
ocomf N fiance with the Building Codes MANUFACTURERS SPECIFICATIONS
of N w York State.
TOV'A1 CAI~ QUEENS ,U46
13UIWING
REVIEWED BY
O-
DATE / i
A
e
har `1►1 04 04: 29p Valued 518-792-5696 p. 3
utility room dining room master
kitchen bath
bath 2
bedroom 3 rbedroom 2livinb room master bedroom
bedroom 3 bedroom 2
buck repo
aco
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