2013-194 ..411ft TOWN OF QUEENSBURY
742 Bay Road,Quecnsbury,NY 12804-5902 518761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20130194 Date Issued: Thursday, July 10, 2014
This is to certify that work requested to be done as shown by Permit Number P20130194
has been completed.
Location: PETRIE Ln
Tax Map Number: 523400-308-006-0001-061-000-0000
Owner: SAMUEL & VIOLA WAHNON
Applicant: DEE ANDERSEN
This structure may be occupied as a:
Mobile Home In Park By Order of Town Board
1117 Pe-\-'t e 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
other issues and conditions as a result of approvals by the Planning Board Director of Building& Code 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: P20130194 Application Number: A20130194
Tax Map No: 523400-308-006-0001-061-000-0000
Permission is hereby granted to: DEE ANDERSEN
For property located at: PETRIE Ln
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: SAMUEL&VIOLA WAHNON Mobile Home In Park $84,000.00
39 SARATOGA ROAD Total Value $84,000.00
GANSEVOORT,NY 12831
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2013- 194 47 Petrie Lane
Mobile Home 24 x 52
$174.72 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,May 16,2014
(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 Townue sbury 4Th d y 16,2013
SIGNED BY for the Town of Queensbury.
Director of Building& Code Enforcement
r
1 OFFICE USE ONLY
3 0% L0r 11 3� �� DATE ISSUED: 1//7I47Zr
TAX MAP N0. PERMIT NO.
PERMIT FEE APPROVALS: ZONING TOWN CLERK MAY 1 2013
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: pet') 103(2__5c®et Name: T Vv\ UM—P./ONO
Address: J 2 6,.\( edok tf- Address: ) (NO IJ' �(
(3.t,wd 5 \01,1)2y 4--0-KLCe U� 1T 4:1 NYi
Phone No. 2-2- C�'� �-�I Phone No. Q 7 2'6 I
Parcel Information
4-5
�Proposed Date of Placement: V' Property Location: Lt---/ P2-}Y(e ( r e_
Road, Street,Avenue
Name of Mobile Home Park: Que.e,vs6..., V;itcc,4_(if applicable) Tax Map Number: 308.6, —I -6,i
Mobile Home Information Zoning Information
Approximate Value of Home: $ nor) Zoning Classification:
New Home:'z Yes ❑No Size of Property: ft. by ft.
Replacement Home: EYes 'No Existing buildings:
Size of Mobile Home: 2--`"i( ft. by 5 2—ft. Setbacks: front yard ft. rear yard ft.
side yards ft. and ft.
Singlewide: Doublewide:
Number of Rooms: (exclude baths) Accessory Building(s):
Number of Bedrooms: 3
Number of Bathrooms: Z Detached garage:❑1-car ❑2-car n car
D Gas Fireplace ❑Woodstove ❑Wood Fireplace Attached garage: 01-car 02-car ❑ car
Foundation Support: Storage building: EYes ❑No
y Size & Depth Other:
Piers
Water Supply: ❑WellIllunicipal
Runners
Slab Is Septic Permit Required? El Yes lNo
Continued on page 2
Town of Queensbury • Community Development Office • 742 Bay Road, Queensnury, iv r lzou4
1
Name of Installer or Mobile Home Dealer: 6 I Pr-S l I I S ry)0E0 Le 5 1 i 10 d tc.16.11.4a4teS -1-if-c--
Address: 1 30(4 .-24— 9 G4hSfVoct/ %- Phone: Si Q - -7 9 e` zB 0 I
MI 1 3I
Complete information below found on a"Plate" or"Sticker"which is affixed to the mobile home:
✓ Insignia serial number: 0 N=7,2_43 c( (-4-e`I14 LQ
✓ Name of manufacturer: NA, ',.L'77--
✓ Plan Approval Number:
✓ Model or Component Designation:
(New home only)
✓ Date of Manufacture:
•it ititiSit iS iS ititiSSSISiSitiSiSitl:.:.:.:.:.:.:...........:...:.....:.:.:.:.....:.......................................... .
•AFFIDAVIT
a
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 :j
ORDINANCE, and all other laws pertaining to the proposed work
shall be complied with, whether specified or not, and that such
s
work is authorized by the owner.
Signature: „,<,.,_ k637.7/,,,,.., ---,....„...,;? Owner, Owner s Aent,Architect, Contractor
a :+
a :,
SPECIAL CONDITIONS OF PERMIT
71
, /' CI
By: 1/ �,-,- V /V" •'
de Enforce ; nt Officer
Town of Queensbury• Community Development Office • 742 Bay Road,\Queensbury, NY 12804
niA)Li Io --1
Queensbury Building & Code Enforcement — Manufactured / Modular Final Inspection
Office No. (518) 761-8256 Arrive: .
am/ part: D _ )am/pm
Date Inspection request received: Inspector's Initials: 0
NAME: Z°- `L'- (\Cl'rs.b PERMIT#: f3- 14 -(1
LOCATION: I €41-1 �1 LCA,r> DATE: / 7 - I o `N/ y
Manufactured Home
Modular Home 6 70v ,1
Footings_ Foundation_ Backfill_ Framing—
Comments:
_Yes_No_N/A
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 sq.ft.per 1,500 sq.ft.
Hot water relief valve piping outside
Deck,porches,steps, railing
Fumace/hot water operating
Garage Fire proofing
Fire Door/Door losers
Plumbing Fixture/3"Vent through roof[Modular]
Foundation insulation[if applicable]
Smoke I Carbon Monoxide Detectors I Interconnected
Final Electrical
Variance required �!
Data Plate okay
/v/ G
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
A_
Okay to issue C/C or CIO[Temp./Perm.] <` c� FR 1 t 0(--)5
Model# Serial# ILA-7
CJ
Manufacturer
Date of Manufacturer
L:1Pam Whiting120101Building Codes FormsWManufadured_Modular Final Inspection_03 0410.doc
m . -ii
Queensbury Building & Code Enforcement— Manufactured / Modular Final Inspection
Office No. (518)761-8256 Arrive: am/pm Depart Cls (cam/pm
Date Inspection request received: Inspector's Initials:
NAME: l Q C 'J,S1_ PERMIT* /_3 — rj/ {�
7
LOCATION: '�`f ) P;.,-rbi LLQ"LCJ{, - DATE: CCS l 4
Manufactured Home \i
Modular Home
Footings_ Foundation_ Backfill_ Framing_
Comments:
Yes o WA
Foundation support,pier spacing,
Per manufacturer
Anchoring per manufacturer 2'from endsV/ze ,
Water line shut aftq. �`�
Sewer line support @ 4 feet /
Heating Crossover[doublewide}off grd. / • : vim < ,k 5
Dryer vented outside
Skirting ventilated 1 sa.ft.aer 1,500 sq.ft.
1//:, ....„--------.
Hot water relief valve piping outside
t.‘,7Deck,porches,steps,railing
Fumace/hot water operating
Garage Fire proofing V
. / e. ,1/404.Ar..i_____ \-------"C:577._____
Fire Door/Door closers
Plumbing Fixture/3"Vent through roof[Modular)
c_e____.(zsi:z.7
Foundation insulation[if applicable] J /
Smoke I Carbon Monoxide Detectors/Interconnected , / V
Final Electrical YY/
Variance required �/ 7
Data Plate okay
Manufactured HUD seal okay ✓
Warranty Seal after January 1,2006 >//
Installers Warranty Seal V
18"x 24"access or 22"x 30"attic access
Vapor retarder under home 6 mil poly or other 4/
911 Street number
Okay to issue C/C or CIO[Temp./Perm.] ism
Model# W10 t 5-T14440 Serial# Lkkik/It l X159!2(
Manufacturer M `
Date of Manufacturer-.. Z 6 \\--2,
L:1Pam Whiting120101Building Codes Forms\Manufactured_Modular Final Inspection_03 04 10.doc
INSTALL NO. 18 5 STATE OF NEW YORK
DEPARTMENT OF STATE
ONE COMMERCE PLAZA
99 WASHINGTON AVENUE
ALBANY,NY 12231
/ 1/ Oxeitsi,�J) LLER'S WARRANTY SEAL
THE PROPERTY OF THE DEPARTMENT OF STATE
C-frfri
ye 6 -71"-- IDE) 111 RELOCATED MANUFACTURED(HUD CODE)
b. n. .�-.4.. „�,uoCt'j�T7T�� r7 r /?{i ]� Serial number -e:W I% 2 09 PA A t,
C. Retailer's name: 110 t -ysG, S 1�J J (� s �'"nr 1 0101 i es t 1�i C
D. Retailer's address: 1?"O H JA o C� — t 1`�Pel O \- / t uj 1 2-6 3
T
E. Retailer's certification#: ; C OD3r7Z Telephone#: 3— 19. — Z ta 0 t
F. Installer's name: 4 V1'\ti ( J• WG 1 +'t 0,--\
G. Installer's address: I 0 ."k,)<A,•Gam A. /4 Qt Coo i Sk.J11 Al -'j I 2.0 fit';
H. Installer's certification#: t 1 / t 3-7 Telephone#: S i - 8 5 —7_ C)5 7
� 1
I. Date installed: .f f/1/3�c:20/,-3 Municipality issuing building permit: cpV t•P'-evl
/�
(City,Town, Village)
J. /Customer name and physical address (911)where home is installed: A r--)acvrS v
L4 r1 Pe.4YLc v t..C.fle,,3 2 L v J ,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: s r1 ; .J Lt--)e;`"! F 1 0v IL—
Signature
—LSignature of Installer or
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