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RC-000749-2017 ow, TOWN OF QUEENSBURY it _ 742 Bay Road,Queensbury,NY 12804-5904 (518) 761-8201 im _____ Community Development - Building& Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: RC-000749-2017 Date Issued: Friday, November 30, 2018 This is to certify that work requested to be done as shown by Permit Number RC-000749-2017 has been completed. Tax Map Number: 308.14-1-52 Location: 2 Timber LN Owner: FOREST PARK MHC, LLC Applicant: FOREST PARK MHC, LLC This structure may be occupied as a: New Manufactured Home 16' x 76' Forest Park MHP: 2 Timber Lane By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the ( a4,014 )0t property owner of the responsibility for compliance with Site Plan, 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-000749-2017 Tax Map No: 308.14-1-52 Permission is hereby granted to: FOREST PARK MHC,LLC 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: FOREST PARK MHC,LLC Mobile Home $40,000.00 Owner Address: 183 Pitcher RD Total Value $40,000.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Combs Trucking 96 VAN DUSEN RD Queensbury,NY 12804 Plans&Specifications New Manufactured Home 16'x 76' Forest Park MHP:2 Timber Lane $145.92 PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,December 10,2018 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town o ueen Frid ,2017 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement Office Use Only c MANUFACTURED HOME Permit#: C_- DCV 7 PERMIT APPLICATIONit Fee:$ q 5,-7 �-- Tbwn of Quceizsbtn w n 742 Bay Road,Queensbury,NY 12804 l5 (� V c Fee: $ P:518-761-8256 www.gueensbury.net D lJ DECD 5 2017 o ce#: Ct 2 TOwN OF QUEENSBURY BUILDING&CODES Project Location: UO"e, t_y�-�" Tax Map ID #: Name of Park: �f,,re � '� Proposed osed Date of Placement: _ -� �"� CONTACT INFORMATION: • Applicant: Name(s): Mailing Address; C/S/Z: r it Cell Phone: _) J i Land Line �i ) ��l f Email: r t�E`c p r h rS ci z • Primary Owner(s): Name(s): `j(ts if (1,S Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • Contractor(s): Business Name: JL-S ��►`31 � 1, Contact Name(s): Mailing Address, C/S/Z:` I 'ever i �;!�f; 64'4 Cell Phone: 5► ) I � � '�[ �(Lt1 J�(tr Land Line: ( 1S' ) 1� - �5 -15F �,�li:�:I,ue(iiti � Email: «k!6 L„e-L-*'LtZ Contact Person for Building & Code Compliance:-) Cell Phone: ) �. iCf ( Land Line: ( ,71 Email: i I,� �� k��i> f'� r i t f r t 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: Place approval #: Model or component designation (New Home Only): Date of manufacture: I S ADDITIONAL INFORMATION: 1. Approximate Value of Home:$ 2. Is the home NEW t' or a REPLACEMENT ? 3. Single-wide N or Double-wide Size: ft. X ft. 4. Foundation support (choose one): Size Depth Piers: Slab: — r 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: ;#of bathrooms: 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? PUBLIC PRIVATE WELL 10. Is the parcel on SEWER or a PRIVATE SEPTIC system? 11. Do you need a septic permit application? No .F` 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: 1 � SIGNATURE: l /� ,.{,��: i % �� DATE: 3 Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017 INSPECTION WORKSHEET (MANMOD-007587-2018) Town of Queensbury - Building and Codes - Fire Marshal 742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal Case Number:RC-000749-2017Case Module:Permit Inspection Date:10/26/2018Inspection Status:Failed Inspector:John O'BrienInspection Type:Manufactured Modular Final Job Address:2 Timber LNParcel Number:308.14-1-52 Queensbury, NY 12804 Contact TypeCompany NameName ApplicantFOREST PARK MHC, LLC\[FOREST PARK MHC, LLC\] Primary OwnerFOREST PARK MHC, LLC\[FOREST PARK MHC, LLC\] ContractorCombs Trucking\[Combs Trucking\] , Granted PermissionFOREST PARK MHC, LLC\[FOREST PARK MHC, LLC\] Checklist ItemPassedComments Building Inspector NotesNO10/26/18 Final Inspection Not Approved Remaining Items: - Install dryer vent to skirting - Remove covers and battery saving tabs from smoke detectors and carbon monoxide detector in order to test. - Install the #2 address number. 4" high numbers - Kitchen sink water pressure needs to be addressed. Foundation support, pier spacing, per manufacturerYES Anchoring per manufacturer 2ft from endsYES Water line shut offYES Sewer line support @ 4 feetYES Dryer vented outsideNO Skirting ventilated 1 sq. ft. per 1,500 sq. ft.YES Hot water relief valve piping outsideYES Deck, porches, steps, railingYES Wood deck: 2'+ from grade dia bracing required - H/CYES ramp compliant Furnace Hot Water Heater operatingYES Plumbing Fixture / 3" Vent through roof \[Modular\]NO Foundation insulation \[if applicable\]YES Smoke Carbon Monoxide Detectors InterconnectedNO Final ElectricalYES Data Plate okayYES Manufactured HUD seal okayYES Warranty Seal after January 1, 2006YES Installers Warranty SealYES Vapor retarder under home 6 mil poly or otherYES Oct 26, 2018Page (2) INSPECTION WORKSHEET (MANMOD-007587-2018) Checklist ItemPassedComments 911 Street numberNO Okay to issue CC or CO \[Temporary / Permanent\]NO10/26/18 Final Inspection Not Approved Remaining Items: - Install dryer vent to skirting - Remove covers and battery saving tabs from smoke detectors and carbon monoxide detector in order to test. - Install the #2 address number. 4" high numbers - Kitchen sink water pressure needs to be addressed. Model #YESNWS-L-26007 Serial #YES122000HA00653A ManufactureYESChampion Date of manufactureYES01/11/2018 O'Brien, John (Inspector) Oct 26, 2018Page (3) INSPECTION WORKSHEET (MANMOD-008392-2018) Town of Queensbury - Building and Codes - Fire Marshal 742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal RC-000749-2017Permit Case Number:Case Module: Fri Nov 30, 2018Passed Inspection Date:Inspection Status: John O'BrienManufactured Modular Final Inspector:Inspection Type: 2 Timber LN308.14-1-52 Job Address:Parcel Number: Queensbury, NY 12804 Contact TypeCompany NameName ContractorCombs Trucking Granted PermissionFOREST PARK MHC, LLC ApplicantFOREST PARK MHC, LLC Primary OwnerFOREST PARK MHC, LLC Checklist ItemPassedComments Building Inspector NotesYES10/26/18 Final Inspection Not Approved Remaining Items: - Install dryer vent to skirting - Remove covers and battery saving tabs from smoke detectors and carbon monoxide detector in order to test. - Install the #2 address number. 4" high numbers - Kitchen sink water pressure needs to be addressed. Okay to issue CC or CO \[Temporary / Permanent\]YES10/26/18 Final Inspection Not Approved Remaining Items: - Install dryer vent to skirting - Remove covers and battery saving tabs from smoke detectors and carbon monoxide detector in order to test. - Install the #2 address number. 4" high numbers - Kitchen sink water pressure needs to be addressed. 11/30/18 Final Inspection Approved - Ok to issueCO! Model #YESNWS-L-26007 Nov 30, 2018Page (1) INSPECTION WORKSHEET (MANMOD-008392-2018) Checklist ItemPassedComments Serial #YES122000HA00653A ManufactureYESChampion Date of manufactureYES01/11/2018 O'Brien, John (Inspector) Nov 30, 2018Page (2)