2002-160 �- TOWN OF OUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
CERUT1
Permit Number: P20020160 Date Issued: Monday,April 22,2002.
This is to certify that work requested to be done as shown by Permit Number P200,20160
has been completed.
Tax Map Number: 523400.309-009-0002-001-000-0000
Location: LUZERNE Rd
Owner: HOMESTEAD VILLAGE L P
Applicant: TARA HART
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: P20020160 Application Number: A20020160
Tax Map No:, 523400-309-009-0002-001-000-0000
Permission is hereby granted to: TARA HART
For property located at: LUZERNE Rd
in the Town of Qu6dAsbury,,to constructor 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. Value
Type of Construction
Owner Address: HOMESTEAD VILLAGE L P Mobile Home In Park 30,000.00
4294 ROUTE 5 Total Value 30,000.00
CALEDONIA,NY,,14423
Contractor or Builder's Name f Address Electrical Inspection Agency
COMBS TRUCKING
VAN DUSEN ROAD
QUEENSBURY.NY 12804
Plans &Specifications
2002-160 TARA HART
75 Alpine Avenue,11onlestead Village MH Park
14' X 66' 1999 MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS
$60.60 ' PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,March 21,2003
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date)
Dated at the T Q 2�b y�March 21,2002
'SIGNED BY . /772-57 1 for the Town of Queensbury.
Avpw-
Director of Building&Co e Enforcement
Application for Permit— Mobile Home
Town of Queensbwy, 742 Bay Road, Queensbury, NY 128
A building permit must be obtained before placement of mobile home on parcel.MNp-iysiBe�t2s-will be made
until a valid building permit has been issued.
Applicant Information WHY
-AKQffi_MU69D CODE
Name:—f:Ae)q I CI File Permit No'.camal U
Address: .-19,5tinar ke6h rM, Fee Paid
(Z)u-Qk n- shar f fi
Review pd By-
�
Phone No.
Property Owner Information ZI Information
Z I.Proobsed Date of Placement:
Name:Na
T �ny L
/#&Vf(Yj ;is Property Location: f)LT%V1 E_
Address: _V N ; 7 , Road,Street Avenue
1 .,.
Name of Mobile Home Park:
(if ap b plka le)
Phone N
Tax Map Number:
c/
Mobile Home Information Zoning Information
Approximate Value of Home:$ M_C)
u. Zoning Classification:
New Home: Yes N
Size of Property: ft.by ft.
0 Replacement Home: Yes VX
Existing buildings:
Size of Mobile Home: ft. by ft.
Setbacks: front yard fL rear yard ft.
Singlewide: Doublewide: Side yards ft.and ft.
Number of Rooms:'(excluide 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: I car; 2 car, car
Storage building: Yes No
Foundation Support: Other:
TYPE SIZE&DEPTH Water Supply: well municipal
Piers x
Runners x Is Septic Permit Required? Yes No
Slab x
Further information requested on the reverse side of this sheet
*m�eofnstaller Mobile Home Dealer:
Address:
Phone No.
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
1. Insignia serial number. WL4 --
2. Name of manufacturer. '
3. Plan Approval Number: 7- )ZL)-3 —C'(—,B
4. Model or Component Designation: V DAE1C_ ufi y3pp
(New Horne OAT 19
5. Date of Manufacture: ( — —91
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.
Si
owner,owner's agent,architect,contractor
Special Conditions of Permit
BY-'
Form: 11/19/1999sh Code Enforcement Officer
-rc~n- cif Ckuqa nst3ury
Building 8c Cocle# I=nfarcetmant
74.2 -E3exy Fkaexci
C)uoe►nst>ury, NY 12804
(518) _761-8256
DATE INSPECTION nl--Qxjlas-r
LOCATION: -
IQ
VMODULAR Ht)ME
OO'
fiznuldatiszma suppcwt, P, r
per zrlmalaf. - ------ vimvloo-<
2- aim<--Ixcori-img p4--ir rnarxxaF- -------- - -- ---
3- Nv.-ttc--r Lixxt-- slX-ut off --- --------- ---- -
4- sewer lijaf-- support � feet -------
-- ---- ------------
- - ------- ----- - -- -
IEKC:pt water rt-Aitay In c)-utsiclf--
PC)ro]af--s, steps, railing .. .. ....
10- -.-.-att--ir cwpv--r.-Ai3aS - ------
I I- g.-tva&yc- fire proofing ------------ -- - --
ILZ- cic>c>r C,-16sfars --- -------- -- ---------- ---
13- plumbing fixture. ......... . .. .. .... ...
14- fo--nmad-atic>rx irtsulaticm (if --:tpPl-)w- ....
15. sXlmc)kf-- clf--ta,(--t-<3rs ------------------- -- -
IC>- filmall electrical ---------- -- -------- ---
17- -vr.%riaricc-- required ----------- ---- - - ---
is- data plate Cykay .................. .. ..
l9- ITICAL-,vilia MIJID sf--"l okay --- - - - - ------
st--rigll
Date of Manufacturer
TO I[SS-LJIF- 4--/<DO YES ND
FtNA� liN�P�CTION �iEP� T - -
Town' cif CQuoensbury
Building ,6k C,"c3a ► Enforc4amont
-742 May tkc3ac! f
C)uo�ensUury►, NY 12804
(51 S) _761-8256
DATE INSPECTION REQUEST
LOCATION.
DATE: LZJ PERMIT
1MMI�SYE.E HOME A����.TLA�i >�I�S�+iL
F+C.)�7I'IN+GS FCJ[JND 'I"'IC3N SAc:�It]�LL F`R.AMING
- N!A YE.S NCB►
1_ foundation support, pier spacing
perrnax. .IA : -------+----- ------ -•--
2_ anchcyr�uag per rnxariuf
3_ water lime slash off ----- ------- --
4_ sewer line support Ca� 4 t --- --
5_ heating crosscaver (dble `de) o grd:
6_ dryer vented outsides- --~=-- ------- - ---_-_ -
7- skirting veratilated' _---• __ _ -- - - ----
8- hot water relief valve pip' g tside 4
9_ deck, porches, steps, rail- ..... ...
lU_ furnacelhot water ope g -------
Ii_ garage fare proofing -- --- --- --- -----
12_ door closers -- - ------------- ---- --- . -
13_ pltxxnbing fixturc - - --------------- - _-
14. foundation irasulatiora (if appl.)-- _-
15_ smac5lce detectcws -------------- ------ - -
IC>- firml electr caul --------------------• All
-
17_ variance required ----- ------ ------- -
18_ data plate okay ---------- - -- - ---- - -
19_ seal cA ay --------- - ---
Model # - Serial #
Nf araufacturer
I?ate of Manufacturer �
tJ AY Tt7 ISSUE ClC7 YES. wc�
C'orxaments: - -
COMMONWEALTH ELECTRICAL INSPECTION SERVICE, IN
Main Office 176 Doe Run Road - Manheim, PA 17545
MUNICIPAL CERTIFICATE 1. ELECTRICAL APPROVAL
' Cu"'t-in Card No,..... ##
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The conditions following governed the issuance of this certificate, and any pertif sate previously issued iq.
eancelled� -
This certificate only covers the electrical equipment and installation conditions as of date. Upon tht
introduction of additional equipment or alterations, application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of making i ctions at any time, and if it;,
P ,
rules are violated, the Company shah have the right to revo a this "e if ate. }
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NOTICE
NOTICE 4NCNORIN6 OF MOBILE HOME
ANCHORING OF MOBILE HOME T0001'OUEENNURY OWNG DE ENT FRAME IS REQUIRED PER
Nosedoa our ambdexami io MANUFACTURERS SPECIFICATIONS
FRAME IS REQUIRED PER compllnceA our amshall
MANUFACTURERS SPECIFICATIONS nd ba construed as indb4 the
cansandsp dricatioas are in81
COTpliance with the�tle;
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S e'
TOWN OF QUA O F I
BUILDING T,
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REVIEWED
BY
DATE RE WE By
DATE
WAKRY
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Aireir's Name ana Muuicto
A,
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Plant No. Made!Designation
Serial No. Date of Mfg.
ow
This manufactured home is designed to com111twith the Federal Manufactured Nome Construction and Safety Standard in force
at the time of manufacture.Design Approual by Underwriters laboratories,Inc.
=actory Installed Equipment Includes. MODEL RATING OF FACTORY INSTALLED CIRCUIT EQUIPMENT
EQUIPMENT MANUFACTURER
DESIGNATION (APPLIANCE NOT FACTORY INSTALLED) SERIAL NUMBER
'if -- 1
t 2
alr,Conditiening 2 - 3 AMM
Range 3
�aoking _ j 4
3uiltin Oven 4 5
countertop Cooking Unit 6 6
_ --
lefrigerator 6 _ loom 7 aW—MM4
Rater Heater 7 — 6
�lothesWasher 8 -- -- � g ,
71o01es Dryer � i 10 '
� —
3'ishwasher 10 � i1
i nod Waste 11 _ 1 --— --�---- 12
Smoke Detector 12 AM
13 I �_.,.�,1_._.�—. — � 13
irepiace 14 _------
14 ----u�--
Instructions for all work to be performed in the field are located in the kitchen drawer.
The maps in this box define the design(Dads for each geographical %,h me to��d°�gn Zone hlhigher wind �e 11 ��ch°�I prowslons,equred for
area.This mantifaotured home has been designed for the roof and ocomVcaastal areas and should not be located within 160T of the coasting in Wind Zones II and III,unless
wind load zones as tihecked: the home and its anchoringg and foundation system have been designed for the increased requnements
spearedforEvosureDin SUASCE7-A
North 40 PSF South 24 PSF and a tenor doorroophenin°gst.F�orhomes esigned to be locateed with storm d Zones ll anted III,which have of been
®Middle 30 PSF 0 Other PSF provided with shutters or equivalent covering de+rices,It is strongly recommended that the home be made
ready to be equipped wish these dewces in accordance with to method recommended In manuhactwers
ROOF LOAD pdntedinstnudons, WIND LOAD
NORTH,
MIDDLE MIDDLE
MIDDLE
N
:ZONE I-
SOUTH 2 ZONE 11
0
ZONE I
NORTH
.o o ZpN
ZONE 111
.� ZONE 11I HI Frtl� ZONE Ii
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