RC-000301-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (5 18)761-8201
Community Development - Building & Cedes (518) 761-8256
BUILDING PERMIT
Permit Number: RC-00O3)1-2016
Tax Map No: 308.14-1-52
Permission is hereby granted to: FOREST PARK. MI-IC, I'l-C
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
Owner Name: FOREST PARK. MI-IC,LLC Mobile Home $20,000.00
Owner Address: 183 Ditcher RD Total Value $20,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Combs Trucking
96 VAN Dl.1SEN RD
Queensbury,NY 128014
Plans&Specifications
924 sq. ft.Mobile Home
75 Gregwood Circle
$ 110.88 PERMIT FEE PAID -THIS PERMIT EXPIRES: Monday, May 15, 2017
(Ifa longer period is required, ars application for ail extension must be made to the code Enforcement Officer
of(fie Town of Queensbury before the expiration date.)
Dated at the Towno` ueenw ury; rid,y 20,16
SIGNED BY: `% for the Tan al`Queensbury.
Director ofBuilding&Code Enforcement
Y
Office Use rJniy
MOBILE HOME APPLICATION
Received
BATE: Tax reap ID
It c
Permit No.
TAX GAAP ICS Permit,Pee
PROPERTY,LCdcAil"IC3N:
NAME OF MOBILE HOME PARI: 34.
PROPOSED DATE SOF PLACEMENTS
P.
I._. CaiJJNER'
APPLICANT. -� w.r',"g��,
ADDRESS f ' vc ADDRESS �
�.w
PHONE _fl _" PHONE
NAME OF INSTALLER-oR MOsILE HOME7 DEALER
ADDRESS: Vculdu&fLn�?4�
PHONE Oig
a
CONTACT—PERSOIV EQ—R SUILI7rN &-CODES COMPLrANC PHONE:
� �C0
COMP LeTE INFORMATION BELOW FO(jND'oN A"PLAtE))-bR-"STICKER"WHICH IS AFFIXED TO THE MOBILE HOME
Insignia serial number C'
Name of MantufacWter _ '', r � _
Place Approval Number
p g _ (Newwr home only)
.model or Component Desi nation
Date of Manufacture: � .
MOBILE HOME iNFORMATi3ON ZONING INFORMATION
Approximate Value of HpmeeLL
_ Zoning
New Home or Replacement Size of property ft.t y ft.
Size of Mooile. ome ft.by ft. Existing bpildings l �
SirlgCew de i t t�oublewuide Accessory buildings
Number of rooss.(eitclude bath)
Storage buildings
Number rat Bedrooms Detached Garage
Number of Bathrooms —
Attached Garage
Cas Fireplace;tPhlaorfstcave orWUood ~ifppiafcp' Setbacks Front yard: ft,
Rear yard:,
-Side yard: ft,.
Foundation gurpoit $ize, Depth Water Supply V4fo€i:
Piers Municipal ..
Runners
Slab Septic Peralit Required? _Yes —No
Town of Queensbury.Building Codes Mobile Horne Application July 2014
Probedure for placing and occupying a mobile home or modular home:
1. Application is submitted and review: 2 copies of plot plan and layout must accompany application along with
septic application (if needed) and fee.
2. Permit is issued- Permit card is placed on property
B. Footing forms are inspected'before pouring concrete: Home is placed on foundation or piers
4. Arrange for electrical inspection-see "Certified Electrical form" on Town website
5. Septic Inspection, if needed
6. Final electrical Inspection
7. Stairs &r platform covering door width and door swing with handrails; on both sides of platform and stairs are
required for all exterior doors.
8. Final inspection
ction by Building &Codes.department
9. All mobile/manufactured*housing must be anchored to the ground upon which they are site per
man.ufacturer reqUWffients.
10. Installer Warranty sea[must be provided at the time of Certificate of Occupancy
11. If anchoring is not possible due to weather conditions or any other item, a Temporary Certificate of Occupancy
will be issued'; Fee-$10: Deposit$100.00(refunded when all items are complete)
DEcLARA,riosv I swear that to the best of my knowledge and belief' the statements contained in this application,
together with th'e 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 completed with,whether specified or not, and that such work4s authorized by
the owner. Installer Warranty.will be provided at time of Certificate of Occupancy.
Print Name: Mag6we 6ekV)nCY\ Date: '511(o lv v
Owner, AUent, Contractor
Signature: -hl aQ,�,� Date: LP
U 0,9
Special Conditions of Permit:
By: Code Enforcement Officer
Town of Queensbur p Ap
.y Buil 8�'Codes Mobito Hom 0iopfloln Jqly 2014