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2004-825 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: P20040825 Date Issued: Monday, June 06, 2005 This is to certify that work requested to be done as shown by Permit Number P20040825 has been completed. Tax Map Number: 523400-308-014-0001-052-000-0000 Location: 183 PITCHER Rd (29 Bxiwood Citcte) Owner: ARC COMMUNITIES 14, LLC Applicant: FOREST MOBILE HOME PARK This structure may be occupied as a: Mobile Home In Park 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 Director of Building&Code Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)'761-8256 BUILDING PERMIT Permit Number: P20040825 Application Number: A20040825 Tax Map No: 523400-308-014-0001-052-000-0000 Permission is hereby granted to: FOREST M013T[,R HOME 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 2004-825 29 BRIWOOD CIRCLE 2004 MOBILE HOME (924 SQ FT) $30.44 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, October 29, 2005 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the T wn of uee ctober 29, 2004 SIGNED BY /�"v for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit— Mobile Home Town of Queensbwy, 742.Bay Road, Queensbury, NY 12804 (518) 7614256. A building permit must be obtained before_placement of mobile home on parcel'. No inspections will be made until a valid building permit has been issued. Applicant In ce]U�se Name: () File Permit Address: 8. Fee Paid to ECG « Reviewed By: - Phone No. OCT2 9 2004 TOWN OF QUEENSBURY Property Owner Information Parcel Information BUILDING AND CODE �� A t� j Proposed Date of Placement: Name: ►V "k / t � Property Location: Address: r�(�(� ly �� o �� Road,Shcet.Mme Nwo ® ZName of Mobile Home Park:-" � � t')1(2- _ rf applicable) - _.. Phond No. Tax Map Number: F Mobile.Home Inform_anon.:-.._-- -- Zoninglxformatron° -. _ .._... _ .... _ APPro- xate Value of Homer .i..m Zoning Classification:�--- -1n New Home: es No Size of Property: ft.by JgL�$. Replacement Home: Yes No Existing buildings: tVA Size of Mobile Home:, ft. by ft. - Setbacks: front yard ft.; rear yard ,J ft. Singlewide: _ Doublewide: Side yards=ft.and ft. i Number of Rooms: (exclude baths) Number of Bedrooms: Accessory Building(s): circle Number of Bathrooms: Detached garage: 1 car, 2 car, car circle: Gas Fireplace/Woodstove I Wood Fireplace Attached garage: 1 car; 2 car, car Storage building: Yes No Foundation Support: Other: TYPE SIZE&DEPTH Water Supply: well or municipal \ Piers x Runners x Is Septic Permit Required? Yes or No Slab x Further information requested on the reverse side of this sheet NCO' -i6�en� I Name of Installer or Mobile Home Dealer_ _ Address: Phone No. I © J 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 ONL19 Date of Manufacture: € AFFIDAVLT Town of -- nsbury:. ._.. - -. _.- .. _.._._..- .. _:.—State ofNeaF-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 BUELDING 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: er, er's agent,architect,contactor Special Conditions of Permit By Form: 11119I1999sh Code Enforcement Officer FINAL INSPECTION REPORT MOBILE / MODULAR Town of Queensbury Building & Code Enforcement / / 742 Bay Road Queensbury, NY 12804 N (518) 761-8256 ARRIVE: DEPART: l t T INSP � ., y DATE INSPECTION REQUEST RECEIVED: NAME: 7 �tiY LOCATION: � I DATE: PERMITN(2Q-625 MOBILE HOME MODULAR HOME FOOTINGS FOUNDATION BACKFILL 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. fiimace/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# Manufacturer Date of Manufacturer OKAY TO ISSUE C/O YES ,-NO Comments: FINAL INSPECTION REPORT MOBILE /.MODULAR Town of Queensbury Building & Code Enforcement . 742 Bay Road Queensbury, 'NY _12864 (518) 761-8256 ARRIVE: DEPART: =L IN i DATE INSPECTION REQUEST RECEIVE NAME: AOL i (CUM. G✓ LOCATION: DATE: ���. --g�S PERMIT# MOBILE HOME MODULAR HOME FOOTINGS FOUNDATION BACI4'ILL 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 a 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. fiunace/hot water operating ........ — 11. garage fire proofing .................... _ 12. door closers ............................ — — 13. plumbing fixture ...................... - 14, foundation insulation (if appl.)...... — �✓ — 15.smoke detectors ....... ........... — — 16. final electrical ........................ -3— — 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: rM r 4 Y aC) - a :z 39 �A�p ��:.;FF �' )PY r;j fil.. M l�PUffNIEN Based on o'Lir li°'r te# c;(a�rtin iic3 , Ccm liance VjLh Our comments Shall not y�e construed as indicafino the Mans and specdficaf ons are in full compliance with the Building Codes of ewr York C? E(C E VE OCT 1 9 2004 J TOV11P1 OF Q1jF1--,N-E�URY BU1LD1i,!G-,e�'. AIICNORING OF MOBILE HOME �, FRAME IS REQUQECD 1CARIONS p ANUFAC�ORERS S M ,r REV1rWE.D DY �� :I C o O ` j. W L F G E M it U. O i dsrinE -L ® " � - - t�IICNT FpTIiRi -- �� 11'. _+�'.°• T.111 f4 r ' T<•t ElllLl g I � ealtA9CP FLu. � •� Ic, I � - � � � 7ml061GITA + + . -�� :Sr.•�LY A]E!/� i1YJ`I - 4!LtE•_i72"7 - y FrAM FAIT MYI IGR i Tlw�mn 1:3LM4ff �•7 'J�dK2 vN1Fl�mt a +seam � , 't• r y � -�T !;_ G :_ � ra MAN 1 t•• , WakfP_Y W 11 ,: _� *tea• ;,� 7w � +�I�. r�SiFSO4Tvo5T - el um .f _ IV li I � `h , r, ',� ` ��+, R SM-IV -6•Y iR' L, T".14 uY M� 4:�' Y. - � �� y alpl°�eausn 28Q3A PF'a Corpora 1. (�'�._ Madison Y!a--f! � •a+rte6au LO i 9J?9r04 FL�ARpI.Vi Ya m u o-14s n ufaof°.ired Fi omw 1�� _ Canserun:iian 3 p�°'rrr.1/,W02'iL. � 5afeCy 55a ncla rd as0 �a;;9�t, TIHO FIGOR PU14 flM ATTANEDCfFT6rADEULSgFAM-6BE] mSESI4TmTOPJMTTNE POLL OWNGH:pDC11 NJV-RECd1FzNEN S; . 11'NG I�7t4@{S�_ i 12_-,_Y.4QF LQdl019L_ ' Mv S_: i•FFLB.SKALL NOT<E 4GTJLL136AA"WDF7USF.I�R- FP 1 nRIHiBR� ?IERs'ir, Rmul G mu WOE L=VS Jn. D y'20 pof SPAL C t7 - - p, p1 51g�hra0g0S rest���kMHC RM 50 tS .04 ti 1 - ro CL r l OCT 1 9 ?004 TOWN OF Q -�,NSSURY BUILDING CODE `d b�