2003-663 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
CE RIr IF I CATE OF OCCUPANCY
Permit Number: P20030663. Date Issued: Tuesday, January 06,2004
This is to certify that work requested to be done as shown by Permit Number P2003.0663
has been completed,
Tax Map Number: 523400-308.014=0001-052-000-0000
Location: 183 PITCHER Rd
Owner: ARC4BFND,L.L.C.
Applicant: FOREST MOBILE HOME PARK
This structure maybe occupied as a:
By Order of Town Board
Mobile Home In Park TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
C,ommuhity Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030663 Application Number: A20030663
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: 'FOREST MOBILE 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: ARC4BFND, L.L.C. Mobile Home In Park $22,000.00
PROPERTY TAX DEPARTMENT Total Value $22,000.00
PO BOX 13244
EL PASO, TX 79913-3244
Contractor or Builder's Name Address Electrical Inspection Agency
Plans&Specifications
2003-663 25 WOODLAND PATH
1216 SQ FT 2003 MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS
$47.96 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,August 18,2004
(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( of
igust 18,2003
7� 0
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit-- Mobile Hume
Town of Queensbwy, 742 Ray Roan Queensbury, NY 12804 (518) 761-82.56
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
mation
office
Name: P 4P-CM- 61',11) 1-. !�� �p1e�{��rk �File Permit No. C3,,'a r� AUG 0 8 2003
Address: ffi Pll.d er P— ' Fee Paid ! TOWN OF 0UEENSSURY
Reviewed By: �..
J
Phone No. Q Q r1
Property Owner Information Parcel Information
Name: APLeff QFn11> t-.L.0 . �l �G� KTncl}C, Proposed Date of Placement: D o
��z�N� �T. 5u t`rE �b0 Property Location: 15 l oc(l f ancL r"
Address: t v UO Road,St wce Avenue
1�En1uEl2 Name of Mobile Home Park: 'rop-c,6 VARK. M 14C...-
(if applicable)
Phone No. Boo a46 54 15
Tax Map Number: 30i 1-t - / 5d:
Mobile Home Information Zoning It formation-
♦ Approximate Value of Home: $
S Zoning Classification:
New Home: -Yes No
LT Size of Property: ft.by 1 � ft.
Replacement Home: Yes No w' ` r tDeml+
r Existing buildings: se-(f Wfcthed
7
Size of Mobile Home: �(/ ft. by 1 P ft.
Setbacks: front yard ft.; rear yard ft.
Singlewide: V Doublewide: Side yards _ft.and ft.
Number of Rooms: (exclue baths) -0--
Number of Bedrooms: Accessory Building(s): circle
Number of Bathrooms: a
Detached garage: I car; 2 car, car
circle: Gas Fireplace 1 Woodstove 1 Wood Fireplace Attached garage: I car, 2 car, car
Storage building: Yes No .
Foundation Support: Other:
DUE SIZE&DEPTH Water Supply. well or unicipal
e x
inners x Slab x Is Septic Permit Required? Yes or No
Further information requested on the reverse side of this sheet W
Name of Installer or Mobile Home Dealer.
Address: —,P 0 r7()C3L-
Phone No.
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
1. Insignia serial`number. ML??(- 5A3
2. Name of manufacturer. K6-r 4oirne-6
3. Plan Approval Number
4. Model or Component Designation: lP 4q q - I
(New Home ONL19
5. Date of Manufacture:
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:
owner,own` 's atent,architecOontmctor
...............................................
Special Conditions of Permit
By.
Form: 1111911999sh Code Enforcement Officer
F i"1a%h�1- 19%A SM W=M=4= O i�i REPORT
Town- of Quo nsbury -
Suilcling 8s Cocles F=nforcc31m+9nt.
. 742 E3dy Fzlpa.d -
+Que+pnsbury, NY 12804
(51 8) 761--8256 ,...�,
> ARRIVE: DEPAR �' NSP: -
BATE INSFECTIO�i REQIJP�ST RECDIVED: � � 3
DAME: �J -
A���iaLE He��SE 1R�+i�1►IRLTL�.�R. Ht�i�t� - _
FG'K:`n.'INGS FCILJI`*TL7.ATIO!N I3ACKFIi -7 - FR..AMINGi -
N/A YES NCD
1_ foundation support, pite:r ,spacing -� -
per rruw uf_ - ---------------------
_ aazclzoring per manuf_ --------------- -
3_ water line shut off -------------------
4_ sewer line support Ca> 4 feet - ------
5_ heating crossover (dblewide� off grd_
6_ dryer vented outsides -- -------------------
7_ skirting vei�tilated - -------------------
_
8- hot water relief valve piping outside
9_ deck, porches, steps, railing --------
10. fttrnacethot water operating _ - _____
11- garage fire proofing --- - --------- - - -- - /
12_ door closers ----------------------
13- plunabig fixture -- - - ------ -- - ---------
14. R3und.ation insulation (if appl.). . .-_-
15_ srnokc detectors ----- -------- - --------- _
16- f-anal elcctrical ......___---- -- -_____---
1`?- variance required -_-_-.----------------
18_ data plate okay -___---_ _- -----__-_-__
19_ mobile HUD seal okay _-_- _- ----•-- ��-
1vlodel # Q M., = Serial ##
Manufacturer :r�C � �� ��
Date of R/Ianufacturer '7��f .�0�
(JKAY TQ ISSUE" CIp YES N#7
P�AiA1_ ilVSPEGTitON REPO -- T _ - _
Town' of Queensbury _
Building SL Coda Enfca)rceam*3nt M
742 .Bay Flcmad
Quo nst>ury, NY 12804
(518) .761-8256
���I2RI VE- I7EF'AR'T: NSP: -
DATE INSPEC'I'IC�N REQUEST RE IVEI3: - -
. DATE: e �� PERMIT #
Mt7►BILE Hi�ME - - MODULAR H®ME -
FC?C7TINGS F+QIJNI3A.'IIC]rN BACKFIi.L FRAMINC3'
N!A IV-IFS Nc>
1_ foundation sup <3r�, pit--r spac g
per malwaf_ ,............................
2_ anchoring per irnanuf. ...............
water ---- --------------- `
4_ sewer line support (W 4 feet -- -_-__ -
S_ heating crossover (dblewade) -off grd_
6_ dryer vented outside" --ti----------------- --
7_ skirting veritilated- -------------------_-
hot water relief valve piping outside
9_ deck, porches, steps, railing
f.�:-r�acefhot water operating ---- ----
11 _ garage fire proofing -_.---- - - -------.
1Z_ door cicasers _. ......___ _ _______________
1 _ plumbing fixture ..:...... . ..... _ .._
1 foundaticnx insulati (if2UPpl-)..... .
1Ei` fiicyal electrical
_ variance ice;cluired . ... .............
18. data plate okay ............. .............
r
l9_ mobile HLJD seal okay ------ --------
Model # - Serial it
Nlariufacturer - _
Date of Mariufacturer 4
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ANCHORING OF MOBILE HOME -
FRAME IS REQRED PER Il
MANUFACTURERS SIECIEICATIONS �
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