2003-662 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804.5902 (518)761-8201
Community Development-Building&Codes (518)761.8256,
CERTIFICATE OF OCCUPANCY ,
PermitN=ber: P20030662 Date Issued: Tuesday, September 30,2003
This is to certify that work requested to be done as shown by Permit Number P20030662
has beeh'completed.
Tax Map Number; 523400-308.014-0001.052.000.0000 .
: Location, 63 Gnegwaad Ccte
Owner: ARC4BFND,L.L.C.
Applicant. FOREST MOBILE HOME PARK
This structure may be occupied as a:
By Order of Town Board
Mobile Home In Park TOWN OF QUEENSBUB.x
Director of Building.&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030662 Application Number: A20030662
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: FORF,ST 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.
PROPERTY TAX DEPARTMENT Mobile Home In Park $22,000.00
PO BOX 13244 Total Value $22,000.00
EL PASO, TX .79913-3244
Contractor or Builder's Name f Address Electrical Inspection Agency
Plans&Specifications
Z003-662 #63 GREGWOOD CIRCLE
1216 SQ FT 2003 MOBLE 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 Town ejbu d A ust 18,2003
SIGNED BY � ? for the Town of Queensb
ury.
urS''•
Director of Building&Code Enforcement
Application for Permit— Mobile Home
Town of Queensbwy, 742 Ray Road, Queensbu7y, 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
Rb
File Permit NoA3-GG1ECF-
Name: -Pvac�IT(�CIj o.i—L.0-
AUG 0 8 2003
Address: , Jq8 -PIRher- �-Cad Fee Paid 4-rl*"
OF c?US&4S
O,LAee,n!�,bur� kl� 1096L� BURY
Reviewed B L!-J!N0 I N
A�LD C
Phone No. r?4-5 - '19 '1
Property Owner Information Parcel Information
� CGT Proposed Date of Placement:Name: flpcff apal> I-J—c N W—
Property-Location: tA 6re(ally)CH CLr
Address: 1.,oOC) &V-A"I- 6T- 6UITE 4qb() R Avenue
--DC-rjL-)EP- co 602-o3-z5X8 Name of Mobile Home Park: �og-e6T�AIZK PAHC-
(if applicable)'
Phone No. &.30 c;46 8,41G Tax Map Number: W&• I
Mobile Home Information Zoning Information
Approximate Value of Home: S
Zoning Classification:
New Home: Yes No
Size of Property: (r,0 ft.by IN ft.
Replacement Home: Yes No
11 is Existing buildings: . [�Iack-e 0(
Size of Mobile Home: t(57 ft. by ft. Setbacks: I from y.ard CR g fL; rear yard ft.
Singlewide: V Doublewide: Side yards A9, ft.and L7�
Number of Rooms: (exclude baths) (.10
Number of Bedrooms: Accessory Buildings): circle
Number of Bathrooms:
Detached garage: I car, 2 car, car
circle: . Gas Fireplace 1 Woodstove/Wood Fireplace Attached garage: I car-, 2 car, car
Storage building: Yes No
Foundation Support: Other:
TYPE, S=&DEPTH Water Supply: well or
Ee�rs X we4��D
Runners X Is Septic Permit Required? Yes or No
Slab X
Furtlier information requested on the reverse side of this sheet W
Name of Installer or Mobile Home Dealer: 46 1 46 ryy
Address: 1�p GN- l 0 P-� Y\-G4L
Phone No. (JFIS) 4
Complete information below found on a"plate'or"sticker"which is affixed to the mobile home.
1. Insignia serial numben -TD ,5 C) 6-c9 4
2. Name of manufacturer.
3. Plan Approval Number:
4. Model or Component Designation:
(New Home OhIT)
5.- Date of Manufacture:
AFFIDAVIT
Z
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.
owner,own agent,arch contractor
.............................................................. ............
Special Conditions of Permit
By
Ferrm: 11119/1999sh Code Enforcement Officer
�T-s�ENA�. iN'�GREGT�Oni REP�R'T _ -
IC
Town of Clueensbury -
Building 8c C:;od*e Enforceiment
4{2�,,, E3ay /�R�o^ad r^��y
Que�:nst3ury, i V I 1 . 804
(51 8) ♦ 61-5256
DATE INSPE ON REQUEST RECEIVED97 ��
ol
LOCATION: 23
DATE.
A�O�III,aE H�1ME - M®IDUZ.Ag! HOME - -
F4J�I`INGS FCJ�LTNDATItJ�i BACKFILL FRAMiN�i.
1_ foundation support, pi+nr spacing
pear rrumallf. . .. ................ .. ...
2_ anclzc�ring per
3_ water line shut off ------------------ "
4_ sewer line support (W 4 feet -..-. - .
5_ heating crossover (dblewide� off grcl_
5_ dryer vented outside _--t_____________ ______
�_ skirting ventilated ---------------- ---- "
8_ hot water relief valve piping outside
9_ deck, gorclies, steps, railing .---__-- -
i o. furnacethot water operating _--___--
11_ garage fire proofirig ------ --- ------- --
12_ door cicisef's ---- - - - -------- - -------- --- --
13- piuxribin -fi g xtur e: ------ ----------------
14. fouridation insulati6t, (if appl.)-_
15_ srnolce detc c:tors ...... .... . .............
16. final electrical .........................
17_ variance required ___...------ - --- ------
Is- data plate c►kay ------------ --------- --
19_ mobile HUD seal okay _______ _______
Model # - Serial #
IVlanufacturer "
Date of Manufacturer
OKAY. T`a iSSUE- (--lC) YES NO
Corn,rrte:t�►ts:
e
. rpmin +af Clueensbury
Builciing St Cc +049 ''Enforcement
74.2, E3Ay FRo2ici
C2ueens'laury, We - 12804
(51 8)- 761-8256 - -
Of
°DATE INSPECTION_ REQUEST RECEIVED: - �
DATE: I +�,3---e�` PERMIT_ #� rt }.._.�� -•
Rx4mxzIY.E HM01%offE al�I�I3�LTLJ��3 HI E
FC}OTINGS F'OUI�TDATIC�N BACKFIi "; _ FRAMINC3- -
YES NCB
-1.,�; fc�►undatic>xi support, pier spacing _ j - .
................ /
2_ ars+chciiring per marixif. _ _________ ____ _
3_ water line shut off - - ----- . --__ -_ --
4_ sewor lmac: support- (90 4 feot _------
5_ �.-ieating crossover (dblewide� off d_- 7_ skirting ventilated _ -_ _ i
$. hot water relief v piping outside
9. deck; porches steps railing ----- --- -
1 O_ Purr acelbiot wa pera tirag - _.. ._ -__
Il_ garage fire prc"Dfing --------- - --------
12_ door closers. .._. _. . _........ .. ...........
13_ plxx.mbing fixture -- ------ - -- ------ --- --
14. foundation irxsulaticin (if appl_)- - - --__
15_ smoke detectors ---- -------- - --- ------
16_ final electrical ------------------------
17_ variance required -----------.----- -- ----
1$_ data plate cikay ---- --- ----------------
19_ mobile HUD seal okay ___- - _-_-__•_
Rczdel # _ �.- --gS�rial ## ► -�, - �- -
Dates of Manufact- x#--r - —
Com-cnerits� - .
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ANCHORING--OF_MOBILE..HQME
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MANdFACTURERS SPECIFICATIONS
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Affordable Residential Communities
FOREST PARK MHC
183 PITCHER ROAD
QUEENSBURY, NY 12804 Q
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PITCHER GOAD