2015-334 TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20150334 Date Issued: Tuesday, August 25, 2015
This is to certify that work requested to be done as shown by Permit Number P20150334
has been completed.
Location: 183 PITCHER Rd
Tax Map Number: 523400-308-014-0001-052-000-0000
Owner: FOREST PARK -- 65 GREGWOOD CIRCLE
Applicant: FOREST PARK -- 65 GREGWOOD CIRCLE
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
owner of the responsibility for compliance with Site Plan,Variance, or (aJw
other issues and conditions as a result of approvals by the Planning Board Director of Building&Code nforc ent
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
411%
ttem 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150334 Application Number: A20150334
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: FOREST PARK MHC, LLC
For property located at: 183 PITCHER 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: FOREST PARK MHC, LLC Mobile Home In Park $60,000.00
31200 NORTHWESTERN Hwy Total value
FARMINGTON HILLS MI 48834-00 $60,000.00
Contractor or Builder's Name /Address Electrical Inspection Agency
COMBS TRUCKING
96 VANDUSEN Rd
OUEENSBURY,NY 12804
Plans&Specifications
2015-334
New mobile home 26 x 44
14 Woodland Path
$137.28 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,July 31,2016
(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 Teu7ee u • r(4 a my 31,2015
i
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
MOBILE HOME APPLICATION
_ Received
DATE: 7 "A6'/j Tax Map ID
TAX MAP ID 8.►L} -I-`n" Permit No. 2oi5'5 } 1
J Pah
Permit Fee — t I ? -.2e ,c1„
PROPERTY LOCATION: I14 000d land Pa. h
NAME OF MOBILE HOME PARK: Iona Park VEL
Lij I
PROPOSED DATE OF PLACEMENT: g- I 0- 2 2u15
T ^;NOF OUEENSBURY
APPLICANT Forest Park. WNER IILDI % .V�?a
ADDRESS le PL.JJ1ef Rd ADDRESS
QLteer 3bLrcfr Ny It key ni(i►' wn
PHONE 5W- 7t4,5-1 I i LU PHONE. (315)116 B 2 - 741-18
NAME OF INSTALLER OR MOBILE HOME DEALER t Gina r14X11 61'1Sfallei>) ifurneJ (y�,tidL N Noryk f (Neem)
ADIDRE�s: VIN F
GyAkee.n5 ,tip N 1 QE/CO
PHONE (510 lci (� cd
a3 C
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE:frty3 LC (16-1(I V16A PHONE: J ---p--1,.5-1-nu, (o )
COMPLETE INFORMATION BELOW FOUND ON A"PLATE"OR"STICKER"WHICH IS AFFIXED TO THE MOBILE HOME
Insignia serial number
Name of Manufacturer elan/poll
Place Approval Number
Model or Component Designation 11-2--A-AP-102- (New home only)
Date of Manufacture: 2,015
MOBILE HOME INFORMATION ZONING INFORMATION
Approximate Value of Home $ 6 01 ()CC Zoning
New Home or Replacement N elf Size of property ft.by ft.
Size of Mobile Home AS ft.by Lly ft. Existing buildings
Singlewide or Doublewide 1>`,J Accessory buildings
Number of rooms(exclude bath) 6 Storage buildings
Number of Bedrooms 3 Detached Garage 1 2 3
Number of Bathrooms of Attached Garage _1 2 _3
Gas Fireplace;Woodstove or Wood Fireplace Setbacks Front yard: ft.
Rear yard: ft.
Side yard: ft.
Foundation Support Size Depth Water Supply Well:
Piers Municipal:
Runners
Slab Septic Permit Required? Yes —No
1
Town of Queensbury Building&Codes
Mobile Home Application July 2014
i -3
Queensbury Building & Code Enforcement — Manufactured / Modular Final Inspection
Office No. (518)761-8256 , <J Arrive: am/p, - *art. ‘'-� 11/pm
Date Inspection request
nreceived Inspector's Initials: i I, .4 .
mow
NAME: 0 -_f S(c fm sz--14 PERMIT#: 1 ' 3
LOCATION: 11;1/ 1,),00 I/l V) I I-1 DATE: ! / c
Manufactured Home ?c
Modular Home
Footings_ Foundation_ Backfill_ Framing—
Comments:
Yes No NIA
Foundation support,pier spacing,
Per manufacturer
Anchoring per manufacturer 2'from endsVre
Water line shut off V/.
Sewer line support @ 4 feet , /
Heating Crossover[doublewide}off grd. :./7"„,Dryer vented outside
Skirting ventilated 1 sq.ft.per 1,500 sq.ft.
Hot water relief valve piping outside /I
Deck,porches,steps,railing . ��i0 .51 . -74-45
Fumace/hot water operating t �
Garage Fire proofing 17 v , G/ 1� t. 1---t-
Fire Door/Door losers
C Z
. TPlumbing Fixture/3"Vent through roof[Modular]
Foundation insulation[if applicable]
Smoke/Carbon Monoxide Detectors/Interconnected
Final Electrical
Variance required
Data Plate okay ✓ f 1 1 \52 \
Manufactured HUD seal okay V \
Warranty Seal after January 1,2006
Installers Warranty Seal ; 7
18"x 24"access or 22"x 30"attic access V
47 .
Vapor retarder under home 6 mil poly or other
911 Street number
Okay to issue C/C or CIO Temp.I Perm.] 1,
Model# 00 '244A01---
L`�1/L Serial# 12Z•`1 -t-1-1V3 ?tAS
Manufacturer OIA-100.1 k. me'7
Date of Manufacturer S\t ,\
h/
L:\Pam Whiting\2010\Building Codes Forms\Manu#actured_Modular Final Inspection_03 04 10.doc
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INSTALL NO. 22361 STATE OF NEW YORK
3' DEPARTMENT OF STATE
Ii ONE COMMERCE PLAZA
jof 99 WASHINGTON AVENUE
ALBANY,NY 12231
INSTALLER'S WARRANTY SEAL
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE
91 NEW MANUFACTURED(HUD CODE) ElRELOCATED MANUFACTURED(HUD CODE) 1
A. Manufacturer's name (3.901/41",
B.
HUD label number: t5 11 b 604, 4 jZ Serial number: lltt-000—i-' '4 0a 3 f 3'A/'3
C. Retailer's name: 1c.>s',E),21 c7 14:TY
D. Retailer's address: ?O ,,,g7,‘.. 4.4,,,/,-..... rtor.> ofd /,JGo/
E. Retailer's certification#: '.. ....-Rch .00 St 3 Telephone#: 913 7W 7'i ci
F. Installer's name: /yfA‘Ii[L� Q.'ti 3$ ,}
G. Installer's address: 5G id ./..S.EirJ ( F,u4L1.12ri -c%f' /84.-41/
H. Installer's certificatio #: /. i/f2IY79/ Telephone#: ft 1, 7961 6-1 51'
I. Date installed: ,Y. fiii /3 Municipality issuing buildin permit: kwS4
(City,'Tow 11age)
J. Customer name and physical address (911)where home is installed: b.qv,c7 41 2/,f L
/3/.,,,,,N,I)4,..4 T74 (_ ,..£ +Sr3t_t )`/ ,New York. /?J (
By attaching this SEAL to this manufactured home,the undersigned Installer of this manufactured home warrants as follows:
1. 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,whether contractually or by operation of law.
Printed Name of Person Signing Seal:4214-ct/LE as..e3S
Signature of Installer or ‘iree......17,Laai
n
Limited Installer:
If you have a problem with your home,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