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TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000736-2016
Tax Map No: 308.12-2-7
Permission is hereby granted to: DKC Holding
For property located at: 43 Minnesota AVE
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
Tvce of Construction
Owner Name: DKC Holding Mobile Home $6,000.00
Owner Address: 6 Holden AVE Total Value $6,000.00
,NY 12804
Contractor or Builder's Name I Address Electrical Inspection Agency
Combs Trucking
96 VAN DUSEN RD
Queensbury,NY 12804
Plans&Specifications
Single-Wide Mobile Home 540 s.f.
13.5 R.x 40 ft.
$64.80 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,October 27,2017
(If a longer period is required,an application for an extensi n must be made to the code Enforcement Officer
of the Town of Queensb ore the ext tin ate.)
Dated at the Town of ueensb (r Th ober 27,2016
SIGNED BY: "" for the Town of Queensbury.
Director of Building&Code Enforcement
MOBILE HOME APPLICATION Office Use Only
�+,.( Received
DATE: [ 1 7 Tax Map ID
TAX MAP ID Permit No. �¢
Permit Fee JR(a Rte
PROPERTY LOCATION:
NAME OF MOBILE HOME PARK:
PROPOSED DATE OF PLACEMENT; Op
APPLICANT 77 C-i, ` �. 1(� OWNER
ADDRESS
iL-tJ Aloe-- AD
DRESS.
_..3.40 t2 - R -7
tVlr \-SNOV
PHONE ! PHONE ` t 9 3 -]X 7 7
NAME OF INSTALLER OR MOBILE HOME DEALER C O l ��
ADDRESS: r ate
PHONE ,3 ;>-77
CONTACT PERSON FOR BUILD/NG&CODES-COMPLIANCE: PHONE:
COMPLETE INFORMATION BELOW FOUND ON A"PLATE"OR'STICKER"WHICH ISIX::r=D:TO THE MOBILE HOME
Insignia serial number �S ��ctq�
Name of ManUfacturer
Place Approval Number
Model or Componeni Designation (New home only)
Date of Manufacture: g 9 qo
MOBILE HOME INFORMATION ZONING INFORMATION
Approximate Value of Home $ Zoning R
New Home or Replacement Size of property tt.by ft
Size of Mobile.Home i3•s ft.by. 4a fL Existing buildings
Singlewide or Doublewide ef, (� Accessory buildings
Number of rooms(exclude bath) Storage buildings
Number of Bedrooms Detached Garage —1 -2 ,Jg
Number of Bathrooms ' Atfacbed Garage ^j —'2
Gas Fireplace;Woodstove'or Wood Fireplace Setbacks Front yard: ft.
Rear yard;,, tt.
Side yard: ft.
Foundation Support Stze Depth Water Supply Well:
Piers l Municipal: —K—
Runners _
Slab Septic Permit Required? XYes _,No
Town of Queensbury Building& Codes1
Mobile Home Application July 2014
Procedure 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
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 Town website
5. Septic Inspection, if needed
6. Final electrical Inspection
7. Stairs & platform covering door width and door swing with handrails on both sides of platform and stairs are
required for all exterior doors.
S. Final inspection by Building & Codes Department
9. All mobile/manufactured housing must be anchored to the ground upon which they are site 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; Deposit$100.00 (refunded when all items are complete)
DECLARATION. I swear that to the best of my knowledge and belief the statements contained in this application,
together with the plans and specification uiar i(ted, are a true and complete statement of all proposed work to be
done on the described premises an at all pr vis' s of the Building Code, the Zoning Ordinance, and all other laws
pertaining to the proposed work all be corn a whether specified or not, and that such work is authorized by
the owner. Installer Warrant ill b o ' d e of Certificate of Occupancy.
Print Name: Date:
4v er ent, Contractor
Signature: Date:
Special Conditions of Permit:
By: Code Enforcement Officer
2
Town of Queensbury Building&Codes Mobile Home Application July 2014
SEPTIC DISPOSAL PERMIT Office Use Only
DATE Oo Lzio l l to Received
�f tax-lhdp ID
TAx MAP ID 305. %,-I- Permit No. 6 201 b
Ti3OPermit Fee
nn '�',, -
LOCATIONOFINSTALLA770N qZZ t J Frn.rB'�a7� ` i�
Approvals:
APPLICANT Cl/ ^ �/ —��ccs [i✓�L_ PHONEIE-MAIL 77 _
ADDRESS
INSTALLERIBUILDER. //'' r� /` t ((��✓� PHONE/E-MAIL
L
ADDRESS: p yXg�Jav
OWNER PHONE/E-MAIL
Address Ca 41&A&.p , -
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE I PHONE—: : (0
RESIDENCE INFORMA77oN
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed _Y N
1981-1991 Spa or Hot Tub installed _Y N
1992-Present O \O
PARCEL INFORMATION
Topography _Flat rolling _Steep slope _%slope
Sal Nature Sand _Loam _Clay _Other
Groundwater At what depth?
Bedrock/Impervious Material At what depth?
Domestic Water Supply Municipal —Well(Uwe][,water supply from any septic system absorption is_fL)
Percolation Test Rate: per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size _\QcoQ gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length 100 ft.;Each trench -2- x So
Seepage Pit with#3 stone How many: :size
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by aTown approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received&approved. The installed system must match the septic system
layout on file-no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant,shall be void. I have read the regulations and
agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: Date:
Signature: Date:
6
Town of Queensbury Building&Codes Principal Structure Application July 2014