2003-819 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030819 Application Number: A20030819
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: FOREST MOBTT,F HOME PARK-14 BRTWOOD CT-
For property located at: 183 PITCHER Rd
in the Town of Queensbury,to constrict 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: ARC4BEND, L.L.C.
PROPERTY TAX DEPARTMENT Mobile Home In Park $23,000A0
PO BOX 13244 Total Value $23,000.00.
EL PAS(O, TX 79913-3244
Contractor or Builder's Name /.Address Electrical Inspection Agency
Plans&Specifications
2003-819 14 BRIWOOD CIRCLE
2003 MOBILE HOME (924 SQ FT)AS PER PLOT PLAN SPECIFICATIONS
$30.44 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, October 06, 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 of Qu sbury; onday,October 06,2003
SIGNED BY Af for the Town of Queensbury.
Director of Buil ing&Ade Enforcement
Ain for Permit— Mobile Home
Town of Queensbwy, 742 Bay.Road,Que ensbu7y, .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 In Off�ce.Use
Name: File Permit No. ��
D Address: ctS�'� r-� -he� � . Fee Paid ��� �� �Ek�t:�
i -rot 2Q��
c,te�nshu lib _...Reviewed By: R�Jp
Phone No. ���'� J
Property Owner Information Parcel.Information
tzCr.T Proposed Date of Placement: 01011 i I aCO3
Name: ARcff Ukl.D -Paley- p4w—, n
BZV�+uT" �aTi . t�E q�tJ Property Location: 4 1 �,lZ t_..E e 6
Address: GP Ub Road;Street,Avenue
Name of Mobile Home Park: lrot?EST %>,Aw M I4C—
rif applfcable) ^ '
Phone No. 800 c;L46 -'-4 t G Tax Map Number: 3A
Mobile Home Information Zoning Information
Approximate Value of Home: S o� K-
Zoning Classification:
New Home: Yes No
Size'of Property: �ft.by�ft.
Replacement Home: Yes No . . W'D'rt-t �PT-W
Existing buildings: 5ec
Size of Mobile Home: L[ ft. by frAp ft.
Setbacks: front yard r�i ft.; rear yard�ft.
Singlewide: Doublewide: Side yards Mo ft.and 3E ft.
Number of Rooms: (exclu,e baths) 6
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:
SIZE&DEPTH Water Supply. well or unicipal
Piers x
Inners x Is Septic Permit Required? Yes or No
Slab x
Further information requested on the reverse side of this sheet
Name of Installer or Mobile Home Dealer. Htj(dow oorne5
Address:_3.0 ._b6X- gocJ Ual is cn SQ. KN
Phone No. �
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
I. Insignia serial number R J A 56 N
2_ Name of manufacturer. CoLu " Q'sm
3. Plan Approval Number: ~M c.�
s
4. Model or Component Designation:
(New Home ONL19
5. Date of Manufacture: c�
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: c
owner,owne !A a ent,architect,t'la=r
Special Conditions of Permit
By:
Form: 1111911999sh Code Enforcement Officer
]F=IlVAIL IINSX=I=—GTEfCMMN REPQ -MT
Town cif Clueensbury
Building 8L Cctd*3 Enfcarcamc3nt
742 Stay Flaacl
Quansbury, NY 12804
DATE INSPECTION REQUEST77 RECEIVED_
LOCATION:
DATE: PERMIT # 1`90
MOBILE H� E M®DULAR I-�+t'I�IE
FC3CYTZNGS FC7LJNDAT'I+C3N BAc.:`KFIi..L FRAMINc3'
' " - :` N'/A • "YES N-C1
1_ foixtida.tioxx supp►>rt, pier spacing
perXYlanuf_ .........................
�. anchorizig per manuf- ---------------
3_ water line shut off ---------------- ---
4- sewer lice support (a� 4 feet
S_ •heating crossover {dbZewide� off grd_ _
6_ dryer vented outside ----- ----------- .--
7_ skirting ventilated - -------------------
8_ hot water relief valve piping outside
9_ deck, porches, steps, railing __- -----
1C}_ operating
11_ garage fire prc3ofirxg ------------- -----
12_ door cicisers --------- - -- ------------ - -
13_ plu.rnbirxg fixture ---------- -- ----------
14_ foundation basulaticwxx (if appl_)......
15_ smoke detectors ------- ----------------
1+5_ final electrical ______ ____ ______________
1'?_ variance required _-- -------- --- - - -----
IS- data plate cilcay ----_................. ..
19_ mr3bi le HUD seai +ralcay --- -- ---------
It - Serial #
IVlariufacturer- -
Date of Manufacturer -
C3KAY TO ISSUE
+C*v • =--�+c +C'�.!= sue--#" +� - Av'
j V i./ r r
RPCF-=-1VED
ySEP 2003
TOWN OF'QUEENSBURY
BUILDING AND CObE
REVIEWED BY:
DATE
-C
'� .1..
TOWN aFQUEF��lS IlRt 'SUILDII4G DEPARTMENT :; F"I !on
Lased on _ .. F py
our qmi
com fiance With our omtnents shall
no#
e construed as indicating the
Plans.and,specifications are in full
compliance vvrith the, uil in
of New York State. CNQRING
{ A NOTICE
OF MOBILE Na.ME' C
FRAME IS REQUIRED PER
i sMANIJFACTLJR
ERS`SPLCIFICATIDIS
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selling dealer and/of local constructor and must be'approvedby a qualified engineer, ,I`
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