2012-450 •
...#11111hi TOWN OF QUEENSBURY
low742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120450 Date Issued: Thursday, May 14, 2015
This is to certify that work requested to be done as shown by Permit Number P20120450
has been completed.
Location: 158 LUZERNE Rd
Tax Map Number: 523400-309-005-0001-001-001-0000
Owner: D&G MANAGEMENT LLC
Applicant: SADRIA INGRAHAM
This structure may be occupied as a:
Mobile Home In Park By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property
(W 4
owner of the responsibility for compliance with Site Plan, Variance, or
other issues and conditions as a result of approvals by the Planning Board Director of Building&Co e Enforcement
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120450 Application Number: A20120450
Tax Map No: 523400-309-005-0001-001-001-0000
Permission is hereby granted to: SADRIA INGRAHAM
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 Mobile Home In Park $35,000.00
PO BOX 2488 Total value
GLENS FALLS,NY 12801-0000 $35,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2012-450 3 Crab Tree Lane
Mobile Home in park-24 x 52
Model#LTE920ct Serial#ZN I 1-0517ABL
Manufacturer PRO 9534/9535 Skyline 9/9/98
$149.76 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, September 19,2013
(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 of Queensbury; Wednesday,September 19,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
I
OFFICE USE ONLY
TAX MAP NO. A PERMIT NO. )c) - k) ,�l/ DATE ISSUED: ° SEP I ate`"' ;
•
PERMIT FEE / 7, /,APPROVALS: ZONING TOWN CLERK ; *6t2Hrip :,
MOBILE HOME -APPLICATION FOR PERMIT:
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 Property Owner Information
Name: -S`Ff tQiA //\)CPZ/9Hr9,/r) Name: SSA,1,-.1A 1/1)1;-4( A47
Address: 3 GI 1 E mNI_ Address: �'/4,1d f kinin
q e.�oS AY Qii&-WF1,5•1)?UF:j
Phone No. 177 - Li iik, ifi Phone No. Si 5)— 7 7 _ 7a
Parcel Information
Proposed Date of Placement: 7 1. Property Location:
Road,Street,Avenue
Name of Mobile Home Park: (if applicable) Tax Map Number:
Mobile Home Information Zoning Information
Approximate Value of Home:$...... 7.
6.3.) Zoning Classification:
New Home: ❑Yes N No Size of Property: ft. by ft.
Replacement Home:,j Yes ❑No Existing buildings:
Size of Mobile Home: 2 if ft. by,,, .:2. ft. Setbacks: front yard ft. rear yard ft.
side yards ft.and ft.
Singlewide: Doublewide: ..-k
Number of Rooms:(exclude baths) Accessory Building(s):
Number of Bedrooms: „_.,1
Number of Bathrooms: Q Detached garage:❑1-car 1-12-car n car
0 Gas Fireplace❑Woodstove 0 Wood Fireplace Attached garage: 1-11-car 1-12-car (] car
Foundation Support: Storage building: ❑Yes ❑No
Type Size & Depth Other:
Piers
Runners Water Supply: ['Well [(Municipal
Slab Is Septic Permit Required? ['Yes El No
Continued on page 2
Town of Queensbury- Community Development Office . 742 Bay Road, Queensvuri/, iv r 'LOU*
Name of Installer or Mobile Home Dealer: 4/0:‹i<0:‹iQ 1,S CM-1-65-
Address:
Address: Phone: /. _ 7 U- =� 7
Complete information below found on a"Plate"or"Sticker"which is affixed to the mobile home:
✓ Insignia serial number:
✓ Name of manufacturer:
v' Plan Approval Number:
/ Model or Component Designation:
(New home only)
✓ Date of Manufacture:
y!i!f f!1!L!t!5R!S!i_i.
AFFIDAVIT
Town of Queensbury State of New York
5 County of Warren
y V
J
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: ,CQnt.„.j.),/ 2
Owner,Owner's agent,Architect, Contractor
C G
:J✓✓.J.J✓✓✓✓✓✓✓✓✓.l:J.J.J✓.J.a:s:J:JiJ✓:J:J.-J✓.J:J.J:J✓.J'�.a:J.J.J:a:a.J.'r✓:J:J.J✓✓.J✓✓:J:J✓✓:J.a✓✓✓./
SPECIAL CONDITIONS OF PERMIT
By: r
ode fore ment Officer
,,INY
Town1143.1.
of Queensbury• ConrmurTatf Develo�rneT Office • 742 Bay gad, Queensbury, 12804
Queensbury Building & Code Enforcement — Manufactured / Modular Final Inspection
Office No. (518) 761-8256 Arrive: . ' '.i-7. •) 1:)- . rt: 7J-t Ian
Date Inspection request received: " Ins �ors Initials: i
NAME: caste is 1.-) I'�‘r1am /ll�01-4-\1 Wi01`aRMIT 1 / a - 9 •S-L)
LOCATION: cq 6 7r'ep, 1,,^ DATE: ' h 1 7j)jC–
Manufactured Home V� :i \\t i
Modular Home /��1,
Footings— Foundation_ Backfill Framing ! ` p q-(`1 -.'a
Comments:
Yes o WA
Foundation support, pier spacing,
Per manufacturer .V
Anchoring per manufacturer 2'from ends
Water line shut off J
Sewer line support @ 4 feet
Heating Crossover jdoublewide}off grd.
Dryer vented outside 4,4
Skirting ventilated 1 sq.ft.per 1,500 sq.ft. 7
Hot water relief valve piping outside4
Deck, porches, steps, railing ✓
Fumace/hot water operating I'
Garage Fire proofing •�vv/
Fire Door!Door closers / 7
Plumbing Fixture/3"Vent through roof[Modular] J
Foundation insulation[if applicable] ✓
Smoke/Carbon Monoxide Detectors/Interconnected /
Final Electrical
Variance required
Data Plate okay
Manufactured HUD seal okay
Warranty Seal after January 1,2006
Installers Warranty Seal D
18"x 24"access or 22"x 30"attic accessV
Vapor retarder under home 6 mil poly or other v' / \I V).12'J
911 Street number
Okay to issue C/C or CIO[Temp.1 Penn.]
Model# 17.Q0.i Serial# .a 341 Y..
Manufacturer CUA vt ,
Date of Manufacturer ° t 1 4..J
L:1Pam Whiting120101Building Codes Forms\Manufactured_Modular Final Inspection_03 04 10.doc
INSTALL NO. 219 2 2 STATE OF NEW YORK
DEPARTMENT OF STATE
ONE COMMERCE PLAZA
444 99 WASHINGTON AVEN U E
ALBANY,NY 12231
INSTALLER'S WARRANTY SEAL
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE
❑ NEW MANUFACTURED(HUD CODE) RELOCATED MANUFACTURED(HUD CODE)
A. Manufacturer's name: aggfrhezi
B. HUD label number:U�,ZYrfSef3l Serial number: 043702,ar�,�
C. Retailer's name:
D. Retailer's address:
E. Retailer's certification#: ' Telephone#:
F. Installer's name: /vi�LµtiG!!
7 •
G Installer's address: y 2 .✓043, C za r /446
H. Installer's certification#: /1-a//79o74/ Telephone#: J Srf' 792 Zf
I. Date installed: Municipality issuing building permit: -`e.
(City, Town, Village)
J. Customer name and physical address (911)where home is installed: 43. 'r��±'Q✓Isc/
coVerzioc azzesa4A-fer ,New York.40Neti
By attaching this SEAL to this manufactured home,the undersigned Installer of this manufactured home warrants as follows:
I. That the installation of this manufactured home meets the standards of the New York State Uniform Fire Prevention and Building
Code.
2. That the Installer is certified as an installer by the New York State Department of State.
The foregoing warranties are in addition to and not in derogation of all other rights and privileges which the consumer may have under any
other law or instrument.The foregoing warranties are in addition to,and not in limitation of or substitution for,any and all other warran-
ties,express or implied,given or made by the Installer,w er contractually or by operation of law.
Printed Name of Person Signing Seal: 0
Signature of Installer or
Limited Installer:
If you have a problem th your hom ,you should first contact your installer or retailer.If the problem is not resolved by the Installer or
Retailer you can contact the Department of State at(518)474-4073.
DOS-1680(Rev.03/09)
Yellow Copy—Department of State White Copy—Retain for Your Records Goldenrod Copy—Permitting Agency Seal—Affix to Home
PVM
Queensbury Building & Code Enforcement — Manufactured / Mo. • ar Final Inspection
Office No. (518)761-8256 Arrive: C-Lie:\litt•
Date Inspection request received: Inspector's Initials:
NAME: n0-1 - ` k)GRA-\\r�'►U1 PERMIT...CRf
LOCATION: 3 1 1 f;- EE Let DATE: -1 - -- Z.
Manufactured Home V ‘F Pk_PkE_
Modular Home
Footings_ Foundation_ Backfill_ Framing_ Z0005 DE_
PpiR\AE_D � = Gn B1) -79Z.--v7
Commends:
Yes No NIA
Foundation support,pier spacing,
Per manufacturer
Anchoring per manufacturer 2'from ends
Water line shut off
Sewer line support @ 4 feet
Heating Crossover[doublewide}off grd.
Dryer vented outside
Skirting ventilated 1 so.ft.Der 1,500 so.ft.
Hot water relief valve piping outside
Deck,porches,steps, railing
•
Fumace/hot water operating
Garage Fire proofing
Fire Door I Door closers
Plumbing Fixture/3"Vent through roof[Modular]
Foundation insulation[if applicable]
Smoke I Carbon Monoxide Detectors/Interconnected
Final Electrical ". -
Variance required 1��,`-'
Data Plate okay EDY
Manufactured HUD seal okay
Warranty Seal after January 1,2006
Installers Warranty Seal
18'x 24"access or 22"x 30"attic access
Vapor retarder under home 6 mil poly or other
911 Street number
Okay to issue CIC or CIO[Temp./Perm.]
Model# L 1 D Serial# Zt \\ 36---CIK -
Manufactur�rP_O
Date of Manufacturer f)Ct---CD 1
L:\Pam Whiting120101Building Codes Forms\Manufactured_Modular Final Inspection 03 04 10.doc