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2004-317 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-820.1 Community Development- Building & Codes (518) 761-8256 . CERTIFICATE . OF OCCUPANCY Permit Number: P20040317 Date Issued: Monday, July 19, 2004 This is to certify that work requested to be done as shown by Permit Number P20040317 has been completed. Tax Map Number: 523400-308-014-0001-052-000-0000 Location: 183 PITCHER Rd Owner: ARC COMMUNITIES 14, LLC Applicant: . FOREST PARK/ARC This structure may be occupied as a: By Order of Town Board Mobile Home In Park TOWN OF QUEENSBURY Director of Building&Code EnNrcement Application for Permit— Mobile Home Town of Queensbury, 742 Bay Road, Queensbury, 1VI' 12804 (518) 761-8256 A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a valid building permit has been issued. Applicant In . Office•Use Name: File Permit No. Address: � 2 Fee Paid L4 9 rot AL Reviewed By: EC E g VE Phone No. NIAY 14 2004 Parcellnform !N OF OUEENSBURY Property Owner Information UILD NO A.11D CODE �oacST Proposed Date of Placement: Name: b a 'Paley- Nw— Property Location: Address: 1o00 a V-ANT' ST. 5tA tTE q6o Road,St=%Avenue ��n11�E12 CO 8�2-0� 5�fi5 Name of Mobile Home Park: lroge,6T—vAR.K M 14C✓ (if applicable) Phone No. &,o (9 I-6 -1.15 Tax Map Number: obi• l -1 ` l d, Mobile Home Information Zoning Information xi Appromate Value of Home: S---18 Zoning Classification: New Home: Yes No Size of Property: ft.by ' ft. Replacement Home: Yes No �-�- -° Existing buildings: Size of Mobile Home: ft. by ft. Setbacks: front yard fh; rear yard ft. Singlewide: Doublewide: Side yards ft.and ft. Number of Rooms: (excI d baths) Number of Bedrooms:' Accessory Building(s): circle Number of Bathrooms: Detached garage: 1 car; 2 car, car circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1 car, 2 car, car Storage building: Yes No Foundation Support: Other: TYPE SIZE&DEPTH Water Supply. well or unicipaI Piers s Runners x Slab x Is Septic Permit Required? Yes or No Further information requested on the reverse side of this sheet AC6 Name of Installer or Mobile Home Dealer: -)d-n /I Address: Po ?)21WL"Sna- Phone No. Complete information below found on a"plate"or"sticker"which is affixed to,the mobile home. I. Insignia serial number. 2. Name of manufacturer. 3. Plan Approval Number : 4. Model or Component Designation: (New Home ONLT) 5. Date'of Manufacture: AFFIDAVIT Town of Queensbury State of New York County of Warren 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 BUILDING CODE,the ZONING ORDINANCE, and all other laws pertaining to the proposed work- shall be complied with,whether specified or not, and that such work is authorized by the owner. r . Signature: owne ,owner's agent, itect,contractor Special Conditions of Permit By: Form: 11/19/1999sh CodeVn rcement Officer � - OE FINAL INsE� 'T'I®N FEE 'T MOBILE / MOOULAR Town of Queensbury Building & Code Enforcement . 742 Bay Road Queensbury, NY 12804 (518) 761-8256 0 0� ARRIVE: aACDEPART: INSP: - DATE INSPECTION REQUEST RECEIVED: NAME: LOCATION: DATE: O PERMIT# o- 311 MOBIILE HOME MODULAR HOME FOOTINGS FOUNDATION BACKFILL FRAMING N/A YES NO 1. foundation support, pier spacing / per manuf. ........................ 4 — — 2. anchoring per manuf. ............... 3. water line shut,off ................... . 4. sewer line support ®4 feet .. — — 5. heating crossover (dblewide) off grd. _-mac _ _ 6. dryer vented outside ...................... � 7.• skirting ventilated .................... ,/ —_ 8. hot water relief valve piping outside ,// — — 9. deck, porches, steps, railing ........ — — 10. f imace/hot water operating ........ 11. garage fire proofing .................. — — 12. door closers ........................... 13. plumbing fixture ...................... —_ 14. foundation insulation (if appl.)...... — — 15. smoke detectors ....................... — — 16. final electrical ........................ — — 17. variance required ..................... - 18. data plate okay ....................... — — 19. mobile HUD seal okay .............. _ Model #�� Serial# PA�1 u'22A-90 Manufacturer \\DMS)i Date of Manufacturer OKAY TO ISSUE C/O YES NO Comments: Y i t X NOTICE ANCHORING OF MOBILE HOME FEiN4c FRAME IS:REQLIIRED PER RECH.VvD Pries r' 14 2004 A' TOWN OF OUEENSBURY SU-�rvG�AN�CODE N O L 1 ES QUIRE ON ALL PA S E DOOR ?►o-�t� �! ETHER ERIOR O ORS EXT OR � 9C p TOWN OF QUEENSBURY BUILDING DEPARTMENT Based on our limited examination, Q(. E t4CE comppliance with our comments shall not he construed as indicating the lans and specifications are in full comp I dog, of New York State. TCV FIT 1 COPY BUILDING & O T. REVIEWED BY. I~ c .w 1 .41 i e ;� t. 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