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2004-824 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
i.' Community Development - Building & Codes (518) 761=8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20040824 Date Issued: Thursday, April 14, 2005
This is to certify that work requested to be done as shown by Permit Number P20040824
has been completed.
Tax Map Number: 523400-308-014-0001-052-000-0000
Location: :17 :BR-1W000 CYCLE
Owner: ARC COMMUNITIES 14, LLC
Applicant: FOREST MOBILE HOME PARK
i
This structure may be occupied as a:
By Order of Town Board
Mobile Home In Park TOWN OF QUEENSBURY
Director of Building&Code En4t�
1'
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040824 Application Number: A20040824
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: FOREST MOBRY,HOMF.PARK
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. Type of Construction Value
Owner Address: ARC COMMUNITIES 14, LLC
900 Mobile Home In Park $18,000.00
Total Value $18,000.00
PO BOX 790830
SAN ANTONIO, TX 78279-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-824 17 BRIWOOD CIRCLE
2004 MOBILE HOME (924 SQ FT)
$30.44 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, October 29, 2005
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the own Que bj; gFtd October 29, 2004
SIGNED BY � 17 for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit— Mobile Home
Town of Queensbwy, 742 Bay Road, Queensbury, NY 12804 (518) 761-8256
A building permit must be obtained before placement of mobile home on parcel..No inspections will be made
until a valid building permit has been issued.
Applicant In formation
Office Use
APBI Fbl@ L?
Name: r File Permit No.
Address: 8. Fee Paid
NU 12&
Reviewed
Phone No.
Property Owner Infor7—
Propertytion LInformafion
R
Proposed Date of Placement:
Name: AI Mb p�1 Location:
Address: u l�r`t�V ► 8 r. �C�� �W Rwd,Sttet,Avme
ame of Mobile Home Park:
Phone No.
Tax Map-Number: _ ./ .._.._ / ..... .
Mobile.Horne Informafign _.._--. Zoning.Ir formation -
Appioximate Value of Homer$ _ f
EC��Ci�E
Zoning Classification:
New Home: Oes No OC I 1 9 200
_ Size of Property: ft.by=t1JWN 01_ QUEENSB RY
Replacement Home: es No BUILDING ANp CO J
Existing buildings:
Size of Mobile Home: ft. by (o6 ft.
Setbacks: front yard P'© ft.; rear yard ft.
Singlewide: _ Doublewide: Side yards�ft.and f
Number of Rooms: (exclude baths)
Number of Bedrooms: 3 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 o municipal
Piers s
Runners x Is Septic Permit Required? Yes or No
Slab x
Further information requested on the reverse side of this sheet
F _
Name of Installer or Mobile Home Dealer.
Address: n 02, JVJ16kLI W
Phone No.
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 ONLY
S_ Date of Manufacture::
_. AFFIDAVIT- -
Town of-- -- _ - .. ... •...• ::.--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_
q
signawre:
owner, er's agent,architect,contractor
i
Special Conditions of Permit
By
Form: 11/19/1999sh Code Enforcement Officer
FINAL INSPECTION REPORT
MOBILE O MOOULAR
Town of Queensbury
Building & Code Enforcement J�
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
��� L�
ARRIVEZEPART``;� ��
.��D INSP:
DATE INSPECTION REQUEST RECEIVED:
NAME: 0
LOCATION: ,r i~ I .l. 1 \ mil, f C
J / j
PERMIT,#
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION BACKF L.L 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, pouches, steps, railing ........
10. furnace/hot water operating ........
11. garage fire proofing ..................
12. door closers ........................... — —
13. plumbing fixture ......................
14. foundation insulation (if appl.)......
15. smoke detectors ....................... 4 —
16. final electrical ........................ 7 —
17. variance required ..................... _
18. data plate okay ....................... — —
19. mobile HUD seal okay .............. _
Model # ,'� �— Seriial#\ �
Manufacturer l�I`l�1��
Date of.Manufacturer`)C-11-Q
OKAY TO IS&bE C/O YES NO
Comments:
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0
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O
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VN '
F11. F jnP
NOTICE
ANCHORING OF MOBILE HOME
TOWN OF OUEENSB0.Y GUIL IV C�-PARTMENT
FRAME IS REQUIRED PER Based o;l odr limited euami{la#ion,
MANUFACTURERS SPECIFICATIONS Corr lisnle tier&our comments shall
not 2 c,.mstrued as irhdicatincg the
plans a„d afe ill full
comp&:C;,,,a;iiEl fi C''13i1 Jinn Cores
y of
RECENED
OCT 1 9 Z004 lU
r
,,. TUNN Of,-- Q'JEENSBURY �.
EU� ILBI v_G AND CODE
REVIEWED BY
LATE CC
r �
RECE,
°E
"_ OCT 1 9 2004
,OWN OF OIJEENSBU L F -n; E m
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