2004-391 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20040391 Date Issued: Wednesday, July 07, 2004
This is to certify that work requested to be done as shown by Permit-Number P20040391
has been completed.
Tax Map Number: 523400-308-014-0001-052-000-0000
Location: 183 PITCHER Rd
Owner: ARC COMMUNITIES 14, LLC
Applicant: BRIAN BESWICK
This structure may be occupied as a:
By Order of Town Board
Mobile Home In Park TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040391 Application Number: A20040391
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: 13RTAN BF,SWTC;K
For property located at: 183 PITCHER Rd
in die 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 Value
Owner Address: ARC COMMUNITIES 14, LLC Mobile Home In Park $35,000.00
600 GRANT St 900 Total Value $35,000.00
DENVER, CO 80203-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-391
LOT 24 WOODLAND PATH
14' X 56'MOBILE HOME
$22.04 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, June 16, 2005
(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��/
f Que bu ; dnesday, June 16, 2004
SIGNED BY for the Town of Queensbury.
r .Y
Director of Building&Col Enforcement
Application for Permit— Mobile Home
Torn of Queensbwy, 742 Bay Road, Queensbury, NY 12804 (518) 761-82.56
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: Alum � ic��rc1� File Permit No.
Address: IS F!7PTLI �iL Fee Paid � O e, ED
61 e"os If-4 k ./Vy /Z-®/ Reviewed By: J UN 0 3 2004
nin i.,
Phone No. 775 � �- BUII_l�t l�`D CDQF Y
Property Owner Information Parcel Information
*tzc-GT Proposed Date of Placement: vpe x6c�
Name: ¢1Re.ff apaD i-•L.0 . ���vlGt -PFqe� A4W
Property Location: e� �/arty . 1/0 Z,
Address: toUO aQAK1 i ST. 5u ITE U) Roan,StmKAienue
DEn1l�El2 : Cd 8�20� 5�-g Name of Mobile Home Park: lroge,6T Vw-K M I4C-
(if applicable)
Phone No. 8CO a46 —04' 15 Tax Map Number: obi• /- l ' / ��
Mobile Horne Information Zoning Information
Approximate Value of Home: -)S'a 000 •
Zoning Classification:A" i
New Home: Ye No
Size of Property: ft.by ft.
Replacement Home: Yes N®
Existing buildings:
Size of Mobile Home: /1 ft. by ft.
Setbacks: front yard fb ; rear yard ft.
Singlewide: _ Doublewide::� Side yards ft.and ft.
Number of Rooms: (exclude baths) 7
Number of Bedrooms: "Z 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 unicipal
Piers x
Runners s Is Septic Permit Required? Yes or No
Slab x
Further information requested on the reverse side of this sheet
Name of Installer or Mobile Home Dealer:
Address: 27/2- 9,;L7e / X /-z-()W
Phone No. .S' O— /3(-S
Mt
$ �
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
1. Insignia serial number
2. Name of manufacturer.
3. Plan Approval Number :
4. Model or Component Designation:
(New Home ONLI)
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 BUELDIlVG 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.
Signature:
owner,owner's agent,architect,contractor
Special Conditions of Permit
By.
Form: 1111911999sh Code Enforcement Officer
FINAL INSPECTION REPORT
MOBILE ® MOOLILAFI
Town of Queensbury
Building &Code Enforcement
742 Bay Road
Queensbury, NY 12804 n
(518) 761-8256
ARRIVE: DEPAR?P.# INSP:
DATE INSPECTION REQUEST RECEIVED:
NAME: l;� - _SC.^ i r 'r
LOCATION: Lr
DATE: PERMIT N D
M0131LE HOME MODULAR HOME
FOOTINGS FOUNDATION BACIU LL FRAMING
N/A YES NO
1. foundation support, pier spacing
per manuf. ........................
2. anchoring per manuf. ............... — — —
3. water line shut,off ................... . — — —
4. sewer line support ®4 feet ....... _ _ _
5. heating crossover (dblewide) off grd. — —
6. dryer vented outside ...................... —
7.• skirting ventilated .................... —_
8. hot water relief valve piping outside — — —
9. deck, porches, steps, railing ........ —
10. fiumce/hot water operating ........ _
11. garage fire proofing ..................
—
12. door closers ........................... — —
13. plumbing fixture ...................... —
14, foundation insulation,(if appl.)......
15. smoke detectors ....................... _
(066 final electrical ........................
17. variance required .....................
18..data plate okay ....................... —_
19. mobile HUD seal okay ..............
Model # Serial#
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments: i 1<;7t—� R o VS
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bey Road
Queensbury, NY 12804 ,a
(518) 761-8256 U J
ARRIVE: DEPART"/ SP:
DATE INSPECTION REQUEST RECEIVED:
NAME:
LOCATION:
150` PERMIT# ._-
_
MOBILE HOMEMODUL&R HOME
FOOTINGS FOUNDATION BACIU LL FRAMING
N/A YES O
1. foundation support, pier spacing
per manuf. ........................
2. anchoring per manuf. ............... —
3. water line shut,off ................... . _
4. sewer line support ®4 feet .......S. heating crossover (dblewide) off grd. —
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 ....................... _ Y —
19. mobile HUD seal okay ..............
Model # Serial# — G�
Manufacturer pf C2 tj AS
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments:
GENE
JUiN 0 3 2004 ..
TO N OF QUEENSB
BU LDING hIND CODE Y
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VA
J �eu-�
;
OTIC�
A{1C''.0 a4 MOBILE HOINE TOWN OFQUEENSEURY BUILDING DEPARTMENT
�I QU Based on odr limited examination,
;S �' I�;ED PER con fiance with our comments shall
MANf� 1 ��;� E SPECIFICATIONS not ge construed as indicating the
plans and specifications are in full
compliance with the Building Codes
of New York State.
IV RY
ri T014 1A U 1- 0;U L
BUILDING G S U.0
REVIEWED BY
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