RC-000451-2017 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-000451-2017 Date Issued: Wednesday, November 29, 2017
This is to certify that work requested to be done as shown by Permit Number RC-000451-2017
has been completed.
Tax Map Number: 308.6-1-61
Location: 34 Petrie LN
Owner: Mary Tucker,Bill Tucker
Applicant:
This structure may be occupied as a: Manufactured Home 28 ft. by 44 ft.
By Order of Town Board
TOWN OF QUEEENNSBU/fRY
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, G(( V
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
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
rJ7
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000451-2017
Tax Map No: 308.6-1-61
Permission is hereby granted to: Glens Falls M&M,Inc.
For property located at: 34 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
Tvce of Construction
Owner Name: Mary Tucker Mobile Home $64,000.00
Owner Address: 2 JOHN CLENDON RD Total Value $64,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Glens Falls M&M,Inc.
1304 State Route 9
Gansevoort,NY 12831
Plans&Specifications
Manufactured Home 28 ft.by 44 ft.
$147.84 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,August 7,2018
(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 exp. tion
Adate.)
Dared at the Town ofeueensb f/ /J4on y us[7,2017
SIGNED BY: 'a for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
MANUFACTURED HOME Permit#:
RC 4S/-a-017
PERMIT APPLICATION Permit Fee: $ 147. 8
Tarn of Queensbun
742 Bay Road,Queensbury, NY 12804 Rec Fee: $ —A
P: 518-761-8256 www.gueensbury.net
Invoice#: D497
Project Location: 3y P<- e Lc,-vi ,c,-7 Tax Map ID #: /C;�-
Name of Park: 2Pnsbv" \/11 �GC�_ Proposed Date of Placement:
F E C E 0 V Err-T
CONTACT INFORMATION:
• Applicant:
Name(s): I c O TU;;J. OF UUEENSSURY
Mailing Address, C/S/Z: 2-
Cell
Cell Phone: ( 51S ) LtF3o -cI-7R-7 Land Line: �)
Email:
Primary Owner(s):
Name(s): SG vy\ o. 5
Mailing Address, C/S/Z:
Cell Phone: A Land Line:
Email:
• Contractor(s):
Business Name: Glens PIIS MaI6,4 ar..,d (1'loc�Jla.��e5"Tc-
ContactName(s):Sgm�I � l n-ir�- v
Mailing Address, C/S/Z: /3 p�7 9����vovif /U-/
Cell Phone: -( -:52/6 )��-0576 Land Line: ( Si 9 )�9 S- Z S4 /
Email: /7,1
YS 9J�essC��
"\�,Contact Person for Building & Code Co�,/mpliance: -�
Cell Phone: �_)�J-7 cs-(g Land Line:
Email:
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017
MANUFACTURED HOME INFORMATION:
(INFORMATION FOUND ON THE PLATE OR STICKER LOCATED IN THE HOME):
Insignia serial #: 112-2-- avv— u ')A oO y Z3 S AS
Name of Manufacturer: W►,a ;on / A+keze�A' C -
Placeapproval#: 40*0Cetk `L�LeI PPSIIIS` g79 PF- s) I --i"g0Z)
Model or component designation (New Home Only): C-U)-A — -7`I i-i Sd
Date of manufacture: 02 01 to
ADDITIONAL INFORMATION:
1. Approximate Value of Home: $ CD41 CXo 0
2. Is the home NEW ora REPLACEMENT_?
3. Single-wide or Double-wide X , Size: Z 8 ft.X 14C4—ft.
4. Foundation support (choose one): Size Depth
Piers:
Slab:
5. Is the home being placed on a private lot? No Yes (if yes, you must provide stamped engineered
drawings of the permanent foundation plan)
6. Total#of rooms(exclude bathrooms): #of bedrooms: .3 ;#of bathrooms: Z
7. Additional heat source? No Yes_ Choose one,if yes: gas fp_ woodstove_ wood fp
8. Are there any other/existing buildings on the property? Nom Yes Explain:
9. What is the water source? PUBLIC PRIVATE WELL
10. Is the parcel on SEWER or a PRIVATE SEPTIC system? C�tretic SpP�}y�
11. Do you need aseptic permit application? Noy-_ Yes
DECLARATION:
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 NYS Building Code,the Zoning Ordinance and all other laws pertaining to the
proposed work shall be completed with
I have read and agree to the above:
PRINT NAME:
SIGNATURE: Lu uk;= DATE: ��
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017