RC-0336-2023 Office Use Only
MANUFACTURED HOME Permit#4g-C —O'51
PERMIT APPLICATION Permit Fee:$ �U y OD
Town onsbury
742Bayy Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Rec Fee: $
Invoice#: . Z/ C
65 Briwood Circle '� FJno I Zone? Y I Reviewed By 1
Project Location: 11
Tax Map ID#: V
Name of Park (if applicable):
Forest PINI!4k CJUN 14 2023
ITVIICUISBURY
F EE LING 8�CODES
PROJECT INFORMATION: W
1. Proposed Date of Placement: 07/01/2023
2. Approximate Value of Home:$ 50,000.00
3: Is the home NEW x or a REPLACEMENT ?
4. Single-wide 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:
10. What is the water source? PUBLIC x PRIVATE WELL
11. What type of wastewater system is on the parcel? SEWER PRIVATE SEPTIC x - -2023
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 #: TBD
Name of Manufacturer: Champion - Decatur
Place approval #:
Model or component designation (New Home Only): 1676H32P01
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: Tyler Schrammel - Community Manager
Cell Phone: ( ) Land Line: ( 518 ) 745-7776
Email: forestpark@rhp.com
Manufactured Home Application Revised January 2021
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JUN 21 2023
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183 Pitcher Road • Queensbury, NY 12804
Office: (518) 745-7776 -
orest pa r.k forestpark@rhp-properties.com • BayshoreHomeSales.com
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