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2004-826 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: P20040826 Date Issued: Monday, June 06, 2005 This is to certify that work requested to be done as shown.by Permit Number P20040826'. -has-been'completed: Tax Map Number: 523400-308-014-0001-052-000-0000 Location: 183 PITCHER Rd (47 Btuwood CiiLc2e) Owner: ARC COMMUNITIES 14, LLC Applicant: FOREST MOBILE HOME PARK This structure may be occupied as a: Mobile Houle In Park By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the P Y 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,Queensbuiy,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040826 Application Number: A20040826 Tax Map No: 523400-308-014-0001-052-000-0000 Permission is hereby granted to: FOREST MnBI[,F,T4nMF,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 2004-826 47 BRIWOOD CIRCLE 2004 MOBILE HOME (924 SQ FT) $30.44 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, October 29, 2005 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town of Queens ry, ri y, October 29, 2004 SIGNED BY W 14 for the Town of Queensbury. Director of Building&Code Enforcement - Ain for Permit—Mobile Home Town of Queensbwy, 742 Bay Road, Queensbury, NY 12804 (518) 761-8256 A building permit must be obtained before placement:of mobile home on parcel. No inspections will be made until a valid building permit has been issued. Applicant Information Office Use Name: �. D File Permit No. n47-A Address: iNd Fee Paid n, t I aeM J-Yj nj- N q�l Reviewed B f , ;fp 11 = Y Phone No. OCT 1 9 2004 01 ParcellnformationO E�SgURY Property Owner Information j Wi�! = C1i Proposed Date of Placement: Name: Property Location: 12 Rr/ &Ck-')h&L6 Address: Q , S13�({� q to Road,Street Avme Name of Mobile Home Park: 6 _.. - e b - - C aPPli le) Phone No. : . \ _ C�• - _ `l.�. ... _.._ a -� Tax Map Number: /. ..._.._ / Mobile.Home Information.-- _..__--. _. -7oning-Infomwion - - Approximate Value of Homer$ -- Zoning CIassification: New Home: es No Size of Property: ft.by L&Ofi- Replacement Home: Yes No Existing buildings: Size of Mobile Home: �ft. by &&ft. Setbacks: front yard�ft.; rear yard ft. Singlewide: Doublewide: Side yards ft.and W ft. Number of Rooms: (exclud 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 municipal Piers x Runners x Is Septic Permit Required? Yes or No Slab x Further information requested on the reverse side of this sheet 211* Name of Installer or Mobile Home Dealer_ Address: 1.�2,D �' J Phone No. 661 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 OMI) Date of Maniifae l&- - AFFID-A VIT_- . i - Town of - Queensbur _ :..• - —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. Signature: owner, a 's agent,aiaitect,contractor i Special Conditions of Permit Form: 11l1911999sh Code Enforcement Officer W WFINAL INSPECTION REPORT MOBILE / MOOULAR Town of Queensbury Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 v ARRIVE: DEPART:\2�aDN DATE INSPECTION REQUEST RECEIVED NAME: b LOCATION: I I.k1 DATE: PERMIT 11 O MOBILE HOME MODULAR HOME FOOTINGS FOUNDATION BACKF 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. furnace/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: r FINIAL INSPECTION REPORT - MOBILE /.MODULAR Town of Queensbury Building & Code Enforcement . 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: DEPART:It�33INS / LO t DATE INSPECTION REQUEST RECEIVED: NAME: LOCATION: DATE: 'V PERMIT#- MOBILE,MOME 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. 2 — 6. dryer vented outside ...................... 7.- skirting ventilated .................... — 8. hot water relief valve piping outside — 9. deck, porches, steps, railing ........ — Y _ 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 ........................ - 17. variance required..................... 18.,data plate okay ....................... — — 19. mobile HUD seal okay .............. model # Serial# Manufacturer Date of Manufacturer " 19---j OKAY TO ISSUE C/O YES N Comments: Y i l .pa Z AP RECS ED 4 OCT T 9 2004 F11 F0 T P OVYN OF QUEENSB URY TOWN OF QUEENISu1JRY 9U LDING DEPARTMENT Based on odr limited examination, -�, com liance 4vith our comments shall __ __[tot-Ee-construed as indicating the plans and specifications are to full a compliance with the Building Codes 3 of New York State. 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