RC-0388-2021 Office Use Only
5 MANUFACTURED HOME Permit#: X 100 202-1
PERMIT APPLICATION
Permit Fee:$
Toxin of Queensbl'17
742 Bay Road,Queensbury,NY 12804
Rec Fee:$ N '�
P:518-761-8256 www.pueensbury.net
Invoice#:
15 Briwood Cirlce Flood Zone? Y Reviewed By:
_J
Project Location: v
Tax Map ID#: `IA
Name of Park(if applicable): Forest Park MHC, LLC
PROJECT INFORMATION: D C
1. Proposed Date of Placement: 08-01-2021 MAY 2 5 2021
2. Approximate Value of Home:$ 50,000.00
x ? O UILDINGWN OF U&CODESRY
3. Is the home NEW or a REPLACEMENT
4. Single-wide x or Double-wide Size: 16 ft.X 76 ft.= 1216 total square feet
5. Foundation support(choose one): Size Depth
x Piers:
24" 48"
Slab:
6. Is the home being placed on a private lot? No x Yes**
(**if yes,you must provide stamped engineered drawings of the permanent foundation plan)
7. Total#of rooms(exclude bathrooms): 5 ;#of bedrooms: 3 ;#of bathrooms: 2
8. Additional heat source? No x Yes Choose one, if yes: gas fp_ woodstove_ wood fp
9. Are there any other/existing buildings on the property? No x Yes ; Explain:
I
10. What is the water source? PUBLIC x PRIVATE WELL
11. What type of wastewater system is on the parcel? SEWER PRIVATE SEPTIC x
12. Do you need a septic permit application? No x Yes
MANUFACTURED HOME INFORMATION:
(INFORMATION FOUND ON THE PLATE OR STICKER LOCATED IN THE HOME):
Insignia serial #: 112000HDC407267A
Name of Manufacturer: Champion -Topeka
Place approval#:
Model or component designation (New Home Only): D01680 RHPH17616
Date of manufacture:
Manufactured Home Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Forest Park MHC, LLC
Mailing Address, C/S/Z: 183 Pitcher Road Queensbury, NY 12804
Cell Phone: ( Land Line: _( 518 ) 745-7776
Email: forestpark@rhp.com
• Primary Owner(s):
Name(s): Forest Park MHC, LLC
Mailing Address, C/S/Z: 183 Pitcher Road Queensbury, NY 12804
Cell Phone: ( Land Line: ( 518 ) 745-7776
Email: forestpark@rhp.com
❑ Check if all work will be performed by the property owner only
• Contractor(s): (List all additional contractors on the back of this form)
Contact Name(s): Dan Hunt/ Hunt Home Services
Contractor Trade: Site Prep/ Home Set Up
Mailing Address, C/S/Z: 36 Brickoven Rd. Queensbury, NY 12804
Cell Phone: ( 518 ) 361-2931 Land Line:
Email: dirtywhiteboy970@yahoo.com
**Workers' Comp documentation must be submitted with this application**
Contact Person for Compliance in regards to this project: Jack Evans - Community Manager
Cell Phone: ( Land Line: ( 518 ) 745-7776
Email: forestpark@rhp.com
Manufactured Home Application Revised January 2021
c . 4
REQUIREMENTS FOR SUBMITTAL:
1. Completed Manufactured Home permit application
THREE (3) COPIES OF THE FOLLOWING:
2. Structural drawings,which include:
a. Floor plan
b. Foundation plan (see 2015 IRC Appendix E Section AE502:foundation systems)
c. If the home is being placed on a private parcel (not in a manufactured home park or designated
zone),you MUST provide stamped engineered drawings of the permanent foundation plan.
3. Plot plan, using a survey map if possible,which includes:
a. Drawn to scale (i.e. 1 inch = 30 feet)
b. Indicate proposed location, with setbacks
c. Include all structures on the property
d. Include location of water supply (well or water lines)
e. Include location & configuration of septic system or sewer line
ADDITIONAL SUBMITTAL INFORMATION:
1. Installer Warranty seal must be provided prior to issuing Certificate of Occupancy.
2. Any changes to the approved plans prior to or during construction will require the submittal of
amended plans, additional reviews and re-approval.
3. If, for any reason,the building permit application is withdrawn, 30% of the fee is retained by the
Town of Queensbury. After 1 year from the initial application date, 100% of the fee is retained.
4. Workers' Comp insurance information for all contractors involved—REQUIRED, EVEN FOR SOLE
PROPRIETORS
DECLARATION:
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 NYS 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.
I have read and agree to the above:
c� EVA-AS
PRINTNAME: ��'.
SIGNATURE: DATE.
Manufactured Home Application Revised January 2021
NEWYORK STATE OF Department
OPPORTUNITY- of Health
ANDREW M. CUOMO HOWARD A. ZUCKER, M.D.,J.D. LISA J. PINO, M.A.,J.D.
Governor Commissioner Executive Deputy Commissioner
June 11, 2021
Forest Park MHC, LLC
Attn: Joel Brown L 2 2 02:
31200 Northwestern Hwy
Farmington Hills, MI 48334 TOWN OF OUEENSBURY
BUILDING & CODES
RE: Forest Park Mobile Home Court
Facility code: 56-6822
(T) Queensbury, Warren County
Install mobile.homes on Lots 9, 15, 16,49, 58, 69, & 78 Briwood Circle; Lot 17
Gregwood Circle; Lot 12 Timber Lane; and Lot 31 Woodland Path
Dear Joel Brown:
We have this day, approved the plans for the above-referenced project. Application for this
project was initially received on May 24,-2021, with additional information received June 9,
2021, and duly submitted by Jack Evans on form DOH-154 (Notice of Intent)that proposed to:
• Replace an existing 3-bedroom, 14-foot x 66-foot mobile home on Lot 9 Briwood Circle
with a 3-bedroom, 16-foot x 76-foot new mobile home.
• Replace an existing 3-bedroom, 14-foot x 70-foot mobile home on Lot
with a 3-bedroom, 16-foot x 76400t new mobile home.
• Replace an existing 3-bedroom, 14-foot x 70-foot mobile home on Lot 16 Briwood Circle
with a 3-bedroom, 16-foot x 76400t new mobile home.
• Replace an existing 3-bedroom, 16-foot x 76-foot mobile,home on Lot 49 Briwood Circle
with a 3-bedroom, 16-foot x 76-foot new mobile home.
• Replace an existing 3-bedroom, 16-foot x 66-foot mobile home on Lot 58 Briwood Circle
with a 3-bedroom, 16-foot x 76-foot new mobile home.
•. Replace an existing 3-bedroom, 14-foot x 66-foot mobile home on Lot 69 Briwood Circle
with a 3-bedroom, 16-foot x 76-foot new mobile home.
• Replace an existing 3-bedroom, 14-foot x 66-foot mobile.home on Lot 78 Briwood-Circle
with a 3-bedroom, 16-foot x 76-foot new mobile home.
• Replace an existing 3-bedroom, 14-foot x 70-foot mobile home on Lot 17 Gregwood
Circle with a 3-bedroom, 16-foot x 76-foot new mobile home.
• Replace an existing 3=bedroom, 20-foot x 66-foot mobile home on Lot 12 Timber Lane
with a 3-bedroom, 16-foot x 76-foot new mobile home.
Glens Falls District Office,77 Mohican Street,Glens Falls,NY 12801,518-793-3893 1 gfdo@health.ny.gov
• Replace an existing 3-bedroom, 24-foot x 66-foot mobile home on Lot 31 Woodland Path
with a 3-bedroom, 16-foot x 76-foot new mobile home.
The Department has no objection to the proposed action and the work may proceed conditioned
on the following:
1 The new home may not have a garbage grinder, whirlpool bath/spa, or any other high
usage fixtures.
2. If the onsite wastewater treatment systems fail, the systems must be brought into
compliance with current regulations.
3. Approval must be granted by other agencies or municipalities having jurisdiction.
4. Homes and accessory,buildings or structures must be installed such that a minimum
separation distance of:10 feet exists between any home, building or structure on any
other site or parcel of land. If improper separation distances are observed on the above
lots in future inspections, enforcement action will be taken.
Additionally, please note that this approval expires 1 year from the approval date.
Sincerely,
d John C. Schroeder
Senior Sanitarian
NYSDOH - Glens Falls District Office
77 Mohican St.
Glens Falls, NY 12801
(518) 793-3893
Cc: Rebecca C. Bussert,Acting District Director, Glens Falls District Office
Kevin Kenyon; P.E., Glens Falls District Office
Town of Queensbury Building Department
File
P:\Facility Folders\Forest Park Mobile Home Court\Correspondence\Forest Park Lots 9, 15,16,49,58,69,&78 Briwood;Lot 17
Gregwood;Lot 12 Timber;Lot 31 Woodland NOI Approval 06-11-21.Docx
Glens Falls District Office,77 Mohican Street,Glens Falls,NY 12801,518-793-3893 I gfdo@health.ny.gov
16' x 76' Box e*0
PRO PERT I ES america*s home
20,24"x48" INGROUND PIERS
-X-----X----- X-----i—X-----X-----X----=X-----X ——— X------
------- --------=-- ---®•
99.5" 99.5" 99.5" 99.5" 99.5" 99.5" 99.5" 99.5" 99.5" 99.5"
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-——————————————————————-.. ——————————————————————————
2'OC X 8'OC X 8'OC { X : 8'OC X 8'0C X 8'OC X 8'0C X" 8'OC X' 8'OC X_ 8'OC X 2'OC
2' 10, 18, 26' 34' 42' 50' 58, 66, 74'
Community: Forest Park(NY) Site Number: B015
Equals pier location-Note all measurments are to the centers of the piers. Approved: /Z�/i>eee[[ w"IML
Information prepared based upon soil bearing capacity for the Site and calculations performed in accordance with the DAPIA approved factory set up manual.
*** PLEASE NOTE - HOME IS ORDERED WITH PIER SAVERS AND DOOR PIERS ARE NOT REQUIRED PER MANUFACTURER.
THIS INFORMATION IS AVAILABLE ON THE HOME ORDER AS WELL AS THE DATA PLATE FOR CONFIRMATION AT TIME
OF FINAL INSPECTION.
Safety First- All work to be conducted abiding by all industry safety rules & regulations
PROP E RT I ES I america"s hon-le"
Manufactured Home
Drainage
Inground Pier Footing
manufactured home
Gravel bed under home
'/z" per foot drop ,` 24to insure
'�9 no wa er remai sw under home #
for drainage 10' s irtin
into yard to gravel
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m�e,a"���-s•�•®-ice_—.® ® � � ® ® �®.� ®�. �—i.s-�-�-�-�-�rr��
All grade material must be
LEGEND
compacted to a minimum concrete pier
of 90%compaction. footing Existing grade
Width and depth
of foundation pier o a a�qQ = 6" minimum Gravel'
determined by
manufacturers = Rough graded
set up manual E ,.%'<m- to achieve 12" per
-- --=` foot drainage
* Suitable material can replace gravel
Vendor Initials: Illustration 2 in non-frost susceptible areas.
March 2019 For illustration purposes only- Must follow instruction of manufacturers installation manual, HUD CFR 24-3280,3285, 3286 and local codes.
/Safety First- All work to be conducted abiding by all industry safety rules & regulations
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PROPERTIES I america`s home'
ManufacturedHome
Drainage
"Do" all "DoNot"
DO crown and grade site to DO NOT grade site or set the home so
slope away from the home. that water collects beneath the home.
mini0m'um
❑ ❑ ❑
minimum slope r(
'/z" per foot •l is
' minimum
minimum slope
1/2" per foot
Home sites shall be prepared so that there will be no depressions
in which surface water shall accumulate beneath the home.The
area of the site covered by the manufactured home shall be
graded,sloped or mechanically designed so as to provide drainage
from beneath the home.
Vendor Initials: Illustration
March 2019 For illustration purposes only-Must follow instruction of manufacturers installation manual, HUD CFR 24-3280, 3285, 3286 and local codes.
Safety First- All work to be conducted abiding by all industry safety rules & regulations
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PRO PERT I ES I americas home'
Manufactured Home Set
Typical ieal Footing and Pier Design
Shims, when required, are to be used in pairs, must be
4" x 6" x 1" in size, installed in opposite directions and be
fitted and driven tight between 'main I-beam frame and
shims or caps below. Shims can't occupy more than 1"
Main I-beam of vertical height.
Hardwood plates, shims, or other listed materials not
exceeding 2" in thickness.
1/2 x 8 x 16 steel caps, 2 x 8 x16 hardwood caps, or
minimum 1/2" x 8"x16" concrete caps, or other listed
A materials. See§3285.304(b)(2) for cap requirements.
Note - steel caps must be protected by a minimum of a
10 mil coating of an exterior paint or an equivalent
.t� corrosion resistant protection.
,... Single open or closed concrete blocks 8" x 8" x 16"
Less than conforming to ASTM C-90 installed with 16" dimension
36" perpendicular to the main kbean frame. Open cells are
placed vertically on footing. Mortar is not required
in height unless specified in the manufacturers installation
instructions or required by a registered professional
engineer or registered architect.
Typical footing. Solid concrete or other product
approved for the purpose. Footing is placed on firm
undisturbed soil or on controlled fill, free of grass and
organic matter.
See manufacturers In freezing climates, the footing must extend below the
installation manual for „ , frost line or be otherwise protected from the effects of
instructions for piers over 36 In height. frost heave as permitted here-in.
Vendor Initials: Illustration 16
March 2019 For illustration purposes only- Must follow instruction of manufacturers installation manual, HUD CFR 24-3280,3285,3286 and local codes.
vol Safety First- All work to be conducted abiding by all industry safety rules & regulations
ce PROPERTIES I americas homed
Tie-Down Anchoring
RHIP-approved anchoring systems:
•Tie Down Engineering Xi2 System
• Oliver Technologies, Inc. 10E3 Ground Level
• Minute Man Stabilizer Plate
• Central Piers, Inc. Diagnall Frame
Consult manufacturer's installation manual for requirements on frame
Ground Anchor J--'-
a Longitudinal and vertical sidewall anchoring, spaing and quantity of anchor points,
and method and configuration of strapping. 414
When installing anchors, ensure there are no obstruction underneath
the home or potential for damage to underground utilities. Ground anchors and stabilizer plates must be installed at the
Note: Public and private locating of proper angles, frame straps must be wrapped at least one
underground utilities must be completed revolution over top of the main I-beam, as well as multiple
before installing ground anchors. times around the anchor bolt, and must also be properly
tensioned according to the installation instructions.
Note: Straps should be protected at sharp at sharp
corners and when wrapped around the I-beam.
J
Ground Anchor and Strap
Vendor Initials: Illustration 35
April 2020 For illustration purposes only-Must follow instruction of manufacturers installation manual, HUD CFR 24-3280,3285, 3286 and local codes.
ITE SURVEY ' Lot Non-Corner
PROPERTIES HOMES
ameriras horne"
'Community Name: F`6 ra)- Site
City Set Backs: Front Yard: o o Rear Yard (end to end): J 5-4- Side Yard: D
Recommended Home Size: /(,:� -A-) Are Overhead Power Lines Present? 0 Yes 2(No
Considerations in Determining Home Size: zr -►-s�����%Y.c
Source of Home Heating (check box): Natural Gas XPropane Heating Oil Electricity
Please provide a Drawing in the center space above that indicates the elements listed below with measurements:
• Existing pad runners/ribbons or Prers • Existing driveway• Existing approach(walkway to home)
• Locate sewer,,water,electrical • Indicate the location of natural gas hookup,propane tank or heating oil tank,if applicable.
Home Wd Home �•0VZ4,1S Home
Total Length of Site
Distance between homes (Distance from home to curb) Distance-between homes
Total feet between homes
��' Addition, 4 Addition, r
Steps Width Steps
or Deck Width or Deck �
or N_A of Porch of Porch or NA
E. Depth of Porch Depth of Porch B
c
Xf
Carport Carport
Yes'ore ®o
. Yes or
x
size: size:
r
ao .
3g t��.� f
from Distance from Distance
curb to home FShowlocation of any curb to home
ad power line's 'A�
STREET(make measurement . back of curb)
Maximum Building Envelope size: width: \ Length:
Name of person filling out this form: a �v� Date: a/ �_ Form Revised
October 2019
THE INSPECTOR 1
5390 State Route 11,Burke,NY 12917 57 O 556 _ 7 1-k /
1-800-487-0535 www.theelectricalinspector.com
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Date:October 3,2022 Application No.On File:166643 1
THIS CERTIFIES THAT NBS Electric ll14
.0 Only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
/ 18 Dark Bay Road Town of Queensbury I- , ,i'
In the following location: Basement 151Floor 2nd Floor No.of Apt Garage X Attic Outside Commercial Residence X
L.
Was examined on 9/27/22 and found to be in compliance with the requirements of the National Electric Code.
tGFCI Fixture Outlets Receptacles Switches Fixtures Ranges Cookin>Decks Ovens Dish Washers Exhaust Fans Smoke/Heat
' 7 39 29 11 Incandescent Fluorescent Other Amt. K.W. Amt. K.W. Amt. K.W. Amt. K.W. Amt K.W. DetectorsLi
14 25 A
j LED
' Dryers Furnace Motors Dimmers Water Heaters Unit Heaters Multi Outlet Sys. _ Electric Heaters '
Amt K.W. Oil H.P. Gas H.P. Amt. Watt Electric Oil Gas Amt. Rating No.of Feet Amt. _K.w. Amt. K.W. Amt. K.W. Amt. K.W. 4
PA
Transformers Alarm Systems Special Receptacle Panels Motors Signs Track Lighting , Disposal '�
'. Amt. KVA A PS Det. Panel Amt. _ K.W. Amt. No.of circuits Rating Amt. H.P. Amt. No.of Lamps No.of Heads Amt. H.P. /
/V
1 2 50 I 23 100 1
1 2 40 AC 1
1j )1
1 Service Disconnect Equipment Service '
' Amt. Amp. Type Meter I Phase 1 Phase 3 Phase 3 Phase No.of CC. AWG. No.of AWG.of No.of AWG of
' 2W 3W 3W 4W Cond./phase CC.cond. Neutrals Neutrals HI-Legs HI-Legs '
4
Other Apparatus 1�
3 Paddle fans /4
PA
LI
j I,
I Manager �" - 9 '1
This certificate must not be altered in any manner;return to the office of THE INSPECTOR if incorrect. Inspector's credentials can be verified. 1
4.. _ _ _ _ - 11
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