RC-000379-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-000379-2016 Date Issued: Tuesday, August 30, 2016
This is to certify that work requested to be done as shown by Permit Number RC-000379-2016
has been completed.
Tax Map Number: 308.6-1-61
Location: 13 Petrie
Owner: SAMUEL WAHNON
Applicant: Donald King
This structure may be occupied as a:Mobile Home 1,568 sq. ft.
Lot 13 Petrie Lane-Queensbury Village MHP By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the (— D
property owner of the responsibility for compliance with Site Plan, �d
Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
dab 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building&. Codes (518) 761-8256
BUILDING PERMIT
Permit Number: RC-000379-2016
Tax Map No: 308.6-1-61
Permission is hereby granted to: Glens Falls M &M, Inc.
For property located at: 13 Petrie
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: SAMUEL WAHNON Mobile Home $88,000.00
Owner Address: 1304 Route 9 Total Value $88,000.00
Gansevoort,NY 12831
Contractor or Builder's Name I Address Electrical Inspection Agency
Glens Falls M&M, Inc.
1304 State Route 9
Gansevoort,NY 12831
Plans&Specifications
Mobile Home 1,568 sq.ft.
Lot 13 Petrie Lane-Queensbury Village MHP
$ 188.16 PERMIT FEE PAID -THIS PERMIT EXPIRES: Sunday,June 18,2017
(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 ury; Th urs a , J ne 23, 2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code E forcem t
Town of Queensbury Building & Codes office use only
MOBILE HOME APPLICATION Received:
14 !N 20 2016 Tax Map ID: 36 . ,� -1 -10( -
A permit must be obtained before placement of mobile home on parcel. No Permit No.: RC 37q - �Gl
inspections will be made until a valid building permit has been issued. Permit Fee: $ 1 ih+Nr'c �l
Applicant -"4 Vv Property Owner 59 T ,k
Address P-1 L
AJf-2 Address t�
Phone` -140;Z Phone c-�51 2-
Contact Person for Building&Code Compliance: (AA H t���IL� Day Phone: 1 Z�
Name of Installer or 11 Proposed Date of Placement f)l :SY9 0
Mobile Home Dealer t5 "�` C Name of Mobile Home Park '+
Address ' Property Location LZ7-53 e-M62 -e—
Phone Tax Map ID 1 �ZI—i,- S-,j- -
Complete information below found on a "Plate" or"Sticker"which is affixed to the mobile home:
• Insignia serial number: Lb Rt f c
• Name of Manufacturer: 04&Y A` ?`b yj
• Place Approval Number:
• Model or Component Designation: (New home only)
Date of Manufacture:
Mobile Home Information Zoning Information
Approximate Value of Home $ e) C) Zoning
New Home or Replacement 10e-Ii Size of property ft.x N o ft.
Size of Mobile Home ft. by 25-&ft. Existing Building(s) t'
Singlewide or Doublewide .@ Accessory Bldgs.
l
Number of Rooms(exclude bath) Storage Building(s)
Number of Bedrooms Detached Garage _1 car _2 car _3 car
Number of Bathrooms , Attached Garage _1 car _ 2 car _3 car
Gas Fireplace Setbacks Front Yard: feet
Woodstove Rear Yard: feet
Wood Fireplace Side Yard: feet
Foundation Support Size Depth Water Supply Well
' Piers Municipal _
R 1 Runners
Septic Permit Required? �
Slab
Town of Queensbury Building&Codes Mobile Home Permit 518-761-8256
Procedure for placing and occupying a mobile home or modular home:
1. Application is submitted and reviewed: 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
3. Footing forms are inspected before pouring concrete: Home is placed on foundation or piers
4. Arrange for electrical inspection -see"Certified Electrical Form"on the Town's website
5. Septic Inspection, it needed
6. Final Electrical. Inspection
7. Stairs and 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 by Building &Codes Department
9. All mobile/manufactured housing must be anchored to the ground upon which they are sited per manufacturer requirements
10. Installer Warranty seal 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-
$10.00; Deposit-$100.00(refunded when all items are complete)
V 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 completed with, whether specified or not, and that such work is authorized by the owner. Installer Warranty
will be provided at time of Certificate of Occupancy.
Print Name: V14 JAj 41'�A
Signature:
Owner,Owner's Ageni,Contractor
Date: _Lo _�?/ ` r
Special Conditions of Permit:
By: Code Enforcement Officer
Town of Queensbury Building&Codes Mobile Home Permit 518-761-8256
GRADE SURFACE
DESIGN DATA: 77- "LF1 TOWARDS THE SWALE
DESIGN FLOW=-704 GPD FOR TWO UNITS W/THREE BEDROOMS EA fi,TTAL --- _ a
NEW STANDARD FIXTURES, (1.6 GPF&3 GPM MAX.) FRn ''.'t P S(',,11ALLY hjrE'Su
AN ELGIN SYSTEM IS PROPOSED AS A SUBSTITUTION TO PREVIOUSLY r`�.T R4GR��� &�Q
SEEPAGE PITS ) �T�
7-5 MINUTE PERCOLATION RATE W/APP RATE OF 1.7 G/SF pRt�PGS � }
(28) B43 ELGIN MATS REO-D. (4) ROWS OF 7 _� RE(S) OR SIG*
8 OUTLET DBOX W/ SPEED LEVELERS SIGNA7.
1750 GALL DC TANK S I G-NATU
&A-TE
Q1
00 to
c � Q - - - - - - JUN %' 020i6
.r
M T air div of Gil :mo1%,16 URY
lid Dirac, ('-0E)ES
- 0 L61
a; = 2–F10,
C MIN TOWN OF QUE NSBURY
0 '� O B I?DING DEP RTMENT
9 Based on o r limited exa 11r1ation,compliance
COPY 0 with our co ments shall 3.;t be construed as
06 r EF1 L E. indicating t e plans ai -cecifications are in
M Y e-I Z 136" 13'-6" full compliance with the wilding Codes of
New York ate.
LOTS ORIGINALLY A
CALCULATE ADDMO
AND SIZE SHALLOW
2 BR DOUBLE p CONSTRUCT SWALE RAIN INTENSITY, i=:
WIDE MOBILE -� BETWEEN DOUBLE ADDITIONAL AREA F
HOMEWIRE HOMES,GRADE 1960 SF
�O ��� SURFACE TO SWALE TIME - 1 HR
RUNOFF: 2"X 196(
STORAGE CAPACITY
ANCHOR NG 0 MOBILES 70' TIME FOR FULL SW)
FRAM IS R QUIRED HER FOR A 12"DEEP Sly
MANUFAC URERS SPECIFI WNS 12'
Q APPENDIX 75A slrBr
2$' 28' TREATMENT AREA TO
TREATMENT AREA TO
F _T_ 7 _F_ SEPTIC TANK TO WATI
PARKING 24'X20' �
PARKING124'X20'
55.00'
- - - SHUT OFF- - SHUT OFF
ACCESS ROAD B TOWN OF QU N B Y
BUILDING & OD
— — — -- — — — — --ReVIewed-
PI AN - DOUBLE WIDE LOT Date:
SCALE I"= 20'
INSTALL NO. 23363 STATE OF NEW YORK
DEPARTMENT OF STATE
ONE COMMERCE PLAZA
99 WASHINGTON AVENUE
ALBANY,NY 12231
INSTALLER'S WARRANTY SEAL
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE
NEW MANUFACTURED(HUD CODE/) 1 ❑ 1RELOCATED MANUFACTURED(HUD CODE)
A. Manufacturer's name: � (r11/Zt 7 /—i 1 �� +I ► �r7. t P S
B. HUDlabelnumbec PF511(A i;I PFS II40G!jZ2 Serial
' r.
numbe0b�-dc�- N AooZSUUAr?
C. Retailer's name: C I el 1:5 r,.IIS M?J2l l_ q S V11 p A a 1,71 Ffy✓t\>S Y,l�
D. Retailer's address: )304 �� C �-y <a✓o ark I Z8 �\
E. Retailer'scertificationt Telephone '7'7
F. Installer's name: ��/� rvt �p ( n��1G r—v�a� T
G Installer's address: 10 Sr floc (�IiPP I , �i i 1�7 1 Z y
H. Installer's certification#: I I /V I IJCp.3-7 3 Telephone#: Slcq- Z32- S(o��
I. Date installed, /3 20/(,n Municipality issuing building permit:�1.�/� ��✓
/3 F� (Cit ow V 11 )
' I. Customer name and physical address (911)where home isinstalled:�,jil�§ <- o
✓r c/� iS��r-� ,New York
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: 04
Signature of Installer or P
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.03109)
Yellow Copy—Department of State White Copy—Retain for Your Records Goldenrod Copy—ParmiHing Agency Seal—Affix to Home