application a ,
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Office Use Only
x MANUFACTURED HOME Permit#: R-C.-
2.021
PERMIT APPLICATION
Permit Fee:$
Town of Queensbury
742 Bay Road,Queensbury,NY 12804 Rec Fee:$
P:518-761-8256 www.gueensbury.net
Invoice#:
Project Location: ��� ?J�. Tax Map ID #: 3a�,
? I �
Name of Park: ���- ! 11 Proposed tTON
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RZ32021
CONTACT INFORMATION: fQUEENSBSRYING&CODAS
• Applicant: -�
Name(s):
Mailing Address, C/S/Z: 1304 1V) &`A rTSe (166a3— ANY-
('.xv
Cell Phone: S\ ) `dS'( 19 S P1 Land Line: ( S��S) � °1 'W'Z d
Email' mtos
• Primary Owner(s): C ,�
Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
• Contractor(s): 1'
Business Name: le—OS✓ f'AIIS �fl1DI' le �k riAA ' `9
Contact Name(s): Sv4
Mailing Address, C/S%Z: 304
Cell Phone: Land Line:
Email:
Contact Person for Building & Code Compliance: Y�-
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#: �)C51 `"C2cL> -L AQ20c `A
Name of Manufacturer: CA 'PI
Place approval#:
Model or component designation (New Home Only):
Date of manufacture: 0 L__�>
ADDITIONAL INFORMATION:
1. Approximate Value of Home:$ rjb,a
2. Is the home NEW or a REPLACEMENT ?
3. Single-wide or Double-wide A//; Size: 2 -1 ft.X�ft. 1 2,bb 'NAw1
4. Foundation support(choose one): Size Depth v
Piers:
Slab: �Lg/L.7�
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)
6. Total#of rooms (exclude bathrooms): �5_;#of bedrooms:. 7, ;#of bathrooms: t
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 VI/yes
/Yes ; Explain:
9. What is the water source? UBLIC PRIVATE WELL
,,p n
10. Is the parcel on SEWER or a PRIVATE SEPTIC system? �e-
11. Do you need aseptic permit application? No ✓ys 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:
SIGNATURE: �(�J11✓L� DATE:
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited•examination,compliance
tJ
( i� m with our comments shall not be construed as
D indicating the plans and specifications are in
full compliance with the Building Codes of
New York State.
TOWN OF Q02*NIS BURY 305.6-1-61 RC-0146-2021
BUILDINJG 8,CODES Queensbury Village/Sam Wahnon
TOWN OF QUEENSBURY 32 Petrie Ln
BUILDING & CODES DEPT. New Manufactured Home 1200 s.f.
Reviewed B :
Date: CVempM22.01.03dB01-PortR-IBaIRDen-De ens- -11-20-1fl{LAxg,l/16/202112A3.d5 PM.DWG vPDFpc
[NOTE:ALL DROPS SUBJECT TO CHANGE UPON COMPLETION OF PRODUCTION PRINTS
TYPICAL PIER PRINT DESIGN CRITERW HAS BEEN DERIVED FROM DAPJA APPROVEDOESIGNS ONE INCH MAY NEED TO BEADDED TO THEWIDTH
FOR REVIEW ONLY 2.REFER TO THE APPROVED INSTALLATION MANUAL FOR THE FOLLOWING: OF THIS S HOUSE SHEATHING
ON THE UATEWALSE OF OPTIONAL
A.SITE PREPARATION O.S.B.SHEATHING ON THE MATEWALL
MANUFACTURER DISCLAIMER NOTICE B.SOILBEARING CAPACITY
PLEASEREADANDUNOERSTANDTHEFOLLOWINGINFORMATION C.FOOTING DESIGN AND SIZING BITE DETAILB:(TD BE m LETED BY THE I—)
CHAMPION HOME BUILDERS,GOES NOT PER FORM ANY SITE WORK FOR HOMES D.PIER CONSTRUCTION soli BEARMC GPADItt:
IT WILL BE THE RESPONSIBILITY OFTHE DEALER/SITE CONTRACTOR TO INSURE E.ANCHORING
THAT ALL SITE WORKWILL CORRELATE WITH THE UNIT ORDERED. 3.THI5 PIER SUPPORT DESIGN HAS BEEN CREATED SPECIFICALLY FOR THIS SERIAL NUMBER FDDTIND SIZE.
ALL DIMENSIONS SHALL BE VERIFIED BEFORE CONSTRUCTION. 4.PIERS ARE REQUIRED AT BOTH SIDES OF EXTERIOR DOORS IN LOAD BEARING SIDEWWALLS,(
NOTICE TO ALL HOME INSTALLERS:MANUFACTURED HOMES WEIGH SEVERAL PI ERS ARE NOT R EQUIRED IN NON LOAD BEARING END WALLS).'PIER SUPPORT ALTERNATE' FooTlHc srAcwc:
TONS.GO NOTATTEMPTTOINSTAU.HOME ON S RE WITH OUT HAVING DAPIA PAGE FLO1.05.01(MAY ONLY BE US ED ON DOORS LESS THAN 4W WIDE). (COMPLETE ONLY IF DIFFERENTFRON...M
EXPERIENCE,KNOWLEDGE AND UNDERSTANDING OF ALL INSTALLATION 5.BLOCKING IS ALSO REQUIRED AT BOTH SIDES OF OPENINGS Q'OR LARGER IN LOAD B EARING
REQUIREMENTS.FAILURE TO MEETTHESE REQUIREMENTS MAY RESULT W SIDEWALLS OR MATE WALLS. PIER LOAD'
SERIOUS INJURY OR DEATH TD AN INEXPERIENCED INSTALLER.PLEASE READ __ MAR—ELMERERLDAOS'
AND UNDERSTAND THE SET-UP AND INSTALLATION MANUALS SUPPLI ED WITH FRAME SUPPORTIN
POINT LOAD SUPPORT
THIS HOME BEFORE ATTEMPTING INSTALLATION OF ANY MANUFACTURED HOME. � � A B.
C. G
SHELLY 11-20-20
GLENS FALLS—STOCK 2B 6•
EXTER OR DOOR LOCATION
REV.3-16-21 39•_2• B'
WATER INLET EP LI9•
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NOTICE
• ANCHORING OF MOBILEli6ME �D 122-07-B-24803 rt� FOUNPIER DATION PR-10.1
MANUFACTURED BEAUTIFULLY• FRA E IS REQUIRED PER PLAN o7
OMWN BY: F�D9BE(NIYANDCONRDOR1nL
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TOWN OF OUF_ENSBURY
BUILDING 8, CODES
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8'PORCH
OMIT M.BATH
SHELLY 11-20-20 RELOCATE BR#2 CLOSET
MODIFY M.CLCLOSET
GLENS FALLS - STOCK RELOCATE FRONT DOOR
EXTRA WINDOW IN M.BED 561
24"/30"DOORS
3661E 366E 3036
OD u \rrr
MASTE BEDROOM M �oeo II ]5]TTww16 D'
B IKITCHEN
16'-2"X 10-11"R �7 —
—
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DINING
L541 8'-10"X 9'-0"
®
8'PORCH
BEDROOM#2 VING
1 '9X101 X 10'2- " '- 1" 19'� -11
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1 1
MODEL 122-07-B-24803
2 BEDROOM 1 BATH FOR REVIEW ONLY
S6'-O"x 23'-4"
1307 SQ.FT.TOTAL REV.12-21-20
11-20-20 REV.3-16-21
PRO
122-07-B-24803 LIT FLAN RE L-1 0 1
MANUFACTURED BEAU711 ULU- 07
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