RC-000499-2017 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-000499-2017 Date Issued: Tuesday, October 17, 2017
This is to certify that work requested to be done as shown by Permit Number RC-000499-2017
has been completed.
Tax Map Number: 308.14-1-52
Location: 183 PITCHER RD
Owner: RHP Properties
Applicant: Maggie Gannon
This structure may be occupied as a:New Mobile Home 16' x 76'
5 Timber Lane By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, r kt
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
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000499-2017
Tax Map No: 308.14-1-52
Permission is hereby granted to: RHP Properties
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
Tvne of Construction
Owner Name: RHP Properties Mobile Home $50,000.00
Owner Address: 183 PITCHER RD Total Value $50,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Combs Trucking
96 VAN DUSEN RD
Queensbury,NY 12804
Plans&Specifications
New Mobile Home 16'x 76'
5 Timber Lane
$145.92 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 23,2018
(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 a iration date.
Dated at the Town oV�2)
ke August 23,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
MANUFACTURED HOME Permit#: �`�_ tags 1 L j
PERMIT APPLICATION Permit Fee: $ I c{
742 Bay Road,Queensbury,NY 1 8 E C Q t� Rec Fee: $ N'
P:518-761-8256 www. ueensb e
AUG 15 2017 invoice#: 1
TOWN OF QUEENSBURY
BUILDING&CODES
,{ 7
Project Location: �Lt'AAt'1 ; 1G &"L:1 Tax Map ID #: 701:K• ) q
Name of Park: (C �(� Proposed Date of Placement:
CONTACT INFORMATION:
• Applicant:
Name(s): .J
Mailing Address, /S/Z:/8
Cell Phone: Land me: ( 1179
Email:
• Primary Owner(s):
Name(s): 112-cQw- ICU 1-4�j`CT`C1
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
• Contractor(s):
Business Name: ° `s e) -G-1,1. S ?�
Contact Name(s): "'L
Mailing Address, C/S/Z:31 ta' en aul LJ4 QSWJSV ) oD 's�-.P1 , 'S
Cell Phone: (� i J ) IC4(p A4e3`f - ei wL-L Land Line: ( 5i $ ) > - sj,�6 (ek iILLe
Email: 1519 A31
Contact Person for Building & Code Compliance:
Cell Phone: 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 #:
Name of Manufacturer: Chimp 10(1
Place approval #:
Model or component designation (New Home Only): l��.'_L J700i
Date of manufacture: 2017
ADDITIONAL INFORMATION:
1. Approximate Value of Home:$ 1150 d 0C)
2. Is the home NEW ✓ or a REPLACEMENT ?
3. Single-wide V/ or Double-wide Size: _L(.L_ft.X "-](p ft.
4. Foundation support(choose one): Size Death
V Piers: J",it Iq 9
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: J ;#of bathrooms: r
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? No V Yes ; Explain:
9. What is the water source? UBLIC PRIVATE WELL
10. Is the parcel on SEWER or a PRIVATE SEPTIC system? enfsb
11. Do you need a septic permit application? No J 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: Mwic culy)OVI
SIGNATURE: DATE: All I/I U0
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017