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RC-0523-2018TOWN 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-0523-2018 Date Issued: Monday, May 6, 2019 This is to certify that work requested to be done as shown by Permit Number has been completed. RC-0523-2018 Tax Map Number: Location: Owner: 308.14-1-52 53 Gregwood CIR FOREST PARK MHC, LLC Maggie GannonApplicant: This structure may be occupied as a: New Manufactured Home 1232 s.f. 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, Variance, or other issues and conditions as a result of approvals by the Planning Board or Zoning Board of Appeals. Director of Building & Code Enforcement TOWN OF QUEENSBURY [ • ro 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT • Permit Number: RC-0523-2018 Tax Map No: 308.14-1-52 Permission is hereby granted to: FOREST PARK MHC,LLC For property located at: 53 Gregwood CIR 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 Owner Name: FOREST PARK MHC,LLC 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 Manufactured Home 1232 s.f. $ 246.40 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday,August 20,2019 (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 bury; 4Mor d y1 -rgust 20,2018 SIGNED BY: F V for the Town of Queensbury. Director of Building&Code Enforcement Office Use Only • MANUFACTURED HOME Permit#: i2 G' o S Z 3— Z-)C r PERMIT APPLICATION Permit Fee:$ 7 1 , Ce Town of Queensbury 742 Bay Road,Queensbury,NY 12804 Rec Fee:$ �k P:518-761-8256 www.queensburv.net 111 Invoice#: � ��cc,,,�. _c Project Location: �,3 �{�'eq(�It�UG �Ir�l� c�b�l Tax Map ID#: 3 ©s.'. )y -- ( 2- s Name of Park: poorest-PasK Rreposed-late-of-P1e€ement: q I ci qi TECEOM 1E0 , CONTACT INFORMATION: 1 AUG 14. 2018 • Applicant: TOWN OF QUEENSBURY Name(s): BUILDING&CODES ( ) fYlf.rre} aclnnun Mailing Address, /S/Z: 183 Ncher gad iN a jam Cell Phon. : (57 d ) 2 32-1q I O Land Line: (518 )1 2-151 Email: 'Ure64" par u P. rhp -pro ertiec , ac m r • Primary Owner(s): Name(s): ()rune_ uc cove Mailing Address, C/S/Z: Cell Phone: ( ) Land Line: ( Email: • Contractor(s): � /1t.&vc Business Name: OmbS. l,LKJ I-1 meSexv1& s Contact Name(s): C>hc(Y1ie C rn S / !C )4LLwf Mailing Address, C/S/Z:q(.A V&LYILLi,LStrl&id %b / t 119 -8 ride 0\I tYY P,o Cell Phone: (5 lg 1gte-9B34 ( cu- e L d Line: ( 51 5(ok9 l b3 i C Email: IJI 1{ l 61 tr LAI, -tebtyq10 e Vahc>c.›, crvk Contact Person for Building & Code Compliance: J ► a Ic? (�f airy Cell Phone?, (J�g ) .3�--)c 1� Land Lin' (5) ) Email: ire perI e rh pe 1-ie.3 Cm 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: Cillavvipib 6°) Place approval#: Model or component designation (New Home Only): /42," 001-A_2 4+41011 Date of manufacture: tan ADDITIONAL INFORMATION: 1. Approximate Value of Home:$ 50i 000 2. Is the home NEW_ or a REPLACEMENT ? 3. Single-wide or Double-wide V'; Size: 7.e.6 ft.X Li`t ft. 4. Foundation support(choose one): Size Depth / 9 V Piers: i Slab: 5. Is the home being placed on a private lot? No V Yes (if yes,you must provide stamped engineered drawings of the permanent foundation plan) 2 6. Total#of rooms(exclude bathrooms): 5 ;#of bedrooms: ;#of bathrooms: 2. 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 Yes ;Explain: • 9. What is the water source? PUBLIC PRIVATE WELL 10. Is the parcel on SEWER or a PRIVATE SEPTIC system? Ssp\--1 11. Do you need a septic permit application? No N0 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: a\Ctl an? ' jr nov' y�/j/� 1tfI g' SIGNATURE: - / I Lhilah DATE: Town of Clueensbury Building&Code Enforcement Manufactured Home Application Revised May 2017 R8','STALL f ° i�7n_,,. QF r E,R 8n,1-%0O0 1. l �ec�dtnl�� ��2�o C'L�» �� � 'c — i THIS SEAL E lMMACIS THE PROPERTY OF THE DEPARTMENT OF STATE 1 do NEW M , MOTU-RED gaup CODE) f RE-LOOMED MANUFACTURED c up CODE) ICI A. Manufactures nor= a7 1 B. IF.JD flab., berg riS I mo e fFS 1 aslF Serial number: - 24 ,14Co Retailer's tee: 0 Ync5 L , Ee h8et er'soertlf cadon0: 010Telephone#: 4 Iis�ees name: Van€' f($ 0 Installer's address: , �Sstl1er'sce>� rc ,t orntl'I '"` Telephone a ib' �` — l�o a IoDate lr�staledo - 1i " ���r� . -- ,. y is,�aig s� nildir permit: Sa Customer name and physical address (911)where home is installed a r" ,9A 0 (----- C I,AL ` CI -�; ;,_ s . 9New York, I • fof this n r °' firFlows: I r I By attaching this SEAL t®this manufacturedhome,the undersigned Installer t����l°�S�`11"c�,7��.lPj L'eC�s.;iloELSe�Ccd!it r��'`���as�©.� 1. That the installation of this manufactured home meets the standards of the New York State Uniform ire Prevention and Building I Code. 2. That the Installer is certified as an installer by the New York State Department of State. j The foregoing warranties ore in addition to and not in derogation of all other rights and privileges which the consumer may have under thay 1 II i ' other law or rmmrnesrL.The foregoing womanties are in addition to,and not in limitation of or substitution foe;any and all other w - I ties,express or implied,.'Tien or made b.F the; ttaller Rwhether entcractual'yorcy operation oflaw. 11 ted a_me of Person Sing Se,. 0, ' , L U - Slgnature of Installer or t I I El niteA Installer: If you have a problem with your home,you should first contact yinr installer o:retailer.If he pioble ll�is ncpseselved by the Installer or Retailer you can contact the Deportment of State at 515)4 4-4073. 1 I I coy 1680(Rev.03109) - I f 0EG'Cc y—RZG:NR gg,T Koear uuesar i 0ofe wed CDrmPs a at2ncl Acou,y�,� Be _Acma.W'H� a a_ D-o racJu of`'Mate,