2003-439 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030439 Application Number. A20030439
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: TAN[M[YMORRISON
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: ARC4BFND, L.L.C. Mobile Home In Park $19,000.00
PROPERTY TAX DEPARTMENT Total Value $19,000.00
PO BOX 13244
EL PASO, TX 79913-3244
Contractor or Builder's Name Address Electrical Inspection Agency
Plans&Specifications
2003-439 TANDAY MORRISON 16 GREGWOOD CIRCLE
MOVE MOBILE HOME FROM HOMESTEAD VILLAGE TO FOREST MOBILE HOME PARK
$30.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,July 01,2004
(If a longer period is required,an application foran extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
f Dated at the T4 o�5. nsb *—July 01,-2001
SIGNED BY for the Town of Queensbury.
Director of Building 8&Code Enforcement
cl
Appli Permit— Mobile Home �_catiqn,for W O
Town ofQueensbury, 742 Bay Road, Oueensbury, IVY 12804 (�I8),761-8256
A building permit must be obtained before placement of,mobile homer on parcel.. No inspections will be made
until a valid building,permit has been issued.
Applicant It formation m
office Use
---- Ll
Name: 0,.,YY1 File Permit No. l
L9 L
Address: U0 Ave Fee Paid
�eyiewed By -. � -
Phone No.
J(/1v � �.zd03
Property Owner Information T�WN OF QUA Parce nformation
Ur'4,prNc ENS
ot2 T ®'1'ro ose� �k%cement: 1 0
Name: A P Off GPtJD t-.L.0 . a -pp"e K rq w -..
Address: t,�Ud C�+'�Ar,►�'"' �a"f". �t'TE �blJ Property Location: 1 � �'�'��..e�� (��.-R.Y'f�
Roard,—� Avenue
�En�t>E12 Ca Soz.03—a(X8 Name of Mobile Home Park: lroy,cST-v�AIZ.K M RC—
(if applicable)
Phone�No. gGG a45 19 Tax Map Number: 30�
Mobile Home Information Zoning Information
Approximate Value of Home: S �-
Zoning Classification: "
New Home: Yes No day, WtCle
S'e of I'rcrpeity: ���ft.by T5 ft.
Replacement Home: Yes No
/� E isfiug'buildings, *See aI:LG,- .heot ALoL- aja3 n
Size of Mobile Home: ft. by ft. `
Setbacks fro yard 19_ ft-; ear4Yriz'ii�ft•
Singlewide: \X Doublewide: Side_3iarc2 54— fLEiaJ40 ft.
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: I car-, 2 car, car
Storage building: Yes No
[Foundation Support:._. Other:
TYPE SIZE&DEPTH Water Supply- , well or' unicipal
Piers s
Runners lab X Is Septic Permit Required? Yes or No
Furtlier information requested on the reverse side of this sheet W
Name of Installer or Mobile Home Dealer: 0-ilen6 V8-'M5
Address: �U(Ak G61
Phone No.
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
l. Lnsigziia�erial
2. [Name-of manufacturer 9
3. Plan Approval Number:,
4. Model or Component Designation:
(New Home ONZ.Y)
5. FI ate of_Manufacture:-0 19 Gi
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 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:
j//Qu -)
owner,o er' agent,architqo contractor
Special Conditions of Permit
By.
Form: 1111911999sh Code Enforcement Officer
Pii\aL�►L.. iNSPECT10i\i REi�QF�T -
' /IOBiLE /'
- -Pown cs#- C)ucKarisburyr
iG3t,si�ciir�g �. Ct^x-lam► �n�fc�-c�arr��rat
7,42 -E3.aty/ Rrr�d
Qusensbury. NY 1 2SO4
(53 8j 70 1-8256
ARRIVL' DE�AI2T_ IN P_ 6e"
3�A`TE INSPECTIOt`i• REQL3EST RE�EIv _ s
rt-cX -4Ahl-l-1 csrayz
DATES
MflSILE HOME. MC3D= -�,� H41M3MIE
NJ'A YES ND
1_ focmdation �pc�rt„ pier spaciung ��
per mar.i3f_ ------------------
2_ ahcsrig per maixuf ---------------
3_ water li �.e shut cyff -------------------
4_ sewer lice support (! 4 feet -------
- 5_ heatir;g crossover �dblewide) off grd_ ! -
_
7 --------------------
S_ liot water relief va the piping outside
9_ deck. porclies� steps. railing ________
11_ garage fart; prcx� r�g ------------------
-c3cxa.r cle► ,rs _____ ______________________
13_ la►Iumlairxg fixtt i v-- ______________________ -
f dative nnsulaticin Eif appl_>------
s�aolce detectors ------Vj
_ fina►1 electrical __���L��________ -- �- -
7_ variaIIce re4uired ---------------------
IS_ data plate cilcay --------------- ---------
1-9_ mobile HLTF� seai .ol3Y --------------
Model # Serial ,#
lirla�xufacturer - .
i
�`�at C1fAI11Lf13+Ctillt�.I"
- C�K1�Y T4 ISSL3E Cf0 -YES - CIO
-rc~n cA Cluetenst>ury
Muilclino SL 41,:c>cf4B F=nfarc4am4ont
74a M Exy Ftcmxcl
Cluia nsbury, NY 12804 56
(518) 761-8256
ARRIVE ice"DEPAi2T: �S]P:
Ic
DATE iNSPECTIQN REQUEST -EU'VEK]
IL
IL,CPOC.^-'rl4C)rV:
IT #6r
" 1. foundation support, pier spacing
pw--ir rrmumxiF- ------------------------
2. anchoring per manuf -------------
water Ili3r3Lf-- shut,off ------ -- -------- - -
4_ sewer -lineaxlpTvc)ort 4 Be-et .. ...
5- lxtanting— c--rc>ssc>-vc--r 9
(cl en&-icle) c)� rcl-
6_ dryer -Zfarxtea C3-utsiclf-- -- ------------- ----
d 7_ skirting ventilated
rc
----- ----------- -
hot waterntt--r relief valve IL PP1XI Ixtsidla-
9. deck, poi ches, steps, railing ---- ---
JLO- furrixceltiot water cv-f--ratUins -------- - -
11- garage fil7f-- PrCX:Abqg -------- ---- ------ ---
✓12. door closers ------ --- ------------- -- ---
13- plurrit-viriS fixture .................. ....
14. Ec3uiadaticni irjLsvvlatic>rt. (if nppl-)------
Is- sl3ac3kv-- detectors .......................
16- final electrical ..........#
17- required . .............. ......
18- data pLatc-- okay ------------------------
19- mobile I-IT-Jll> seal upluty --------------
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