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2024-0201 Office Use Only MANUFACTURED HOME Permit#: a 2 v �2©I PERMIT APPLICATION Town afeLecn3fiurti Permit Fee:� 0 — 742 Bay Road,Queensbury,NY 12804 / \ P:518-761-8256 www.aueensbury.net Rec Fee.$ Invoice#: QQ�� Project Location: 3'C) , Ca t' 1:\ Flood Zone? Y Reviewed By:C , Tax Map ID#: Name of Park(if applicable):. Otte-A .. ., MAC: PROJECT INFORMATION: 1. Proposed Date of Placement: " e3) I 1 c - 2. Approximate Value of Home:$ QC ) 3. Is the home NEW or a REPLACEMENT ? `,� 4. Single-wide or Double-wide ; Size:\lt' ft.X ' bp ft.= \ \I.L) total square feet 5. Foundation support(choose one): Size Depth.. CPiers: `fil1 `-t2. » Slab: 6. Is the home being placed on a private lot? No __ Yes** (**if yes,you must provide stamped engineered drawings of the permanent foundation plan) 7. Total#of rooms(exclude bathrooms): 3 ;#of bedrooms: ;#of bathrooms: 8. Additional heat source? No jg. Yesn Choose one, if yes: gas fp�n woodstoven wood fp 9. Are there any other/existing buildings on the property? No Yes I 1;Explain: 10. What is the water source? PUBLIC J PRIVATE WELL n 11. What type of wastewater system is on the parcel? SEWER I I PRIVATE SEPTIC 12. Do you need a septic permit application? No 71 Yes I l (if yes, please submit separate septic application) MANUFACTURED HOME INFORMATION: (INFORMATION FOUND ON THE PLATE OR STICKER LOCATED IN THE HOME): Insignia serial#. \ 0 t"/ 51 Name of Manufacturer: ',\'.\ , C, �ti�- APR 29 2024 Place approval #: TOWN OF QUEENSBURY BUILDING& Model or component designation (New Home Only): \lax CO DES Date of manufacture: Manufactured Home Application Revised July 2022 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@rha.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 A7L;- 2519) Revised January 2021 Manu`actured Home Application • 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 a to the above: PRINT NAME: A 5(1 tr16Y,/Yuzj' 9 J � SIGNATU: • rUl��� DATE: /Z4/7 / Manufactured Home Application Revised Januar/2021 • i 6a NEW YORK state department of Nirav R.Shah, M.D.,M.P.H. H EALTI-I Sue Kelly Commissioner A� n 11 y 201ixecutive Deputy Commissioner July 27, 2011 r Thomas R. Center Jr., P.E. Nace Engineering, P.C. • 169 Haviland Rd., •Queensbury,NY 1.2804 • Re: Forest Park Mobile Home Park, Facility#56-6822, Town o sbury, Warren County Onsite Wastewater Treatment System Replacement eject ' 1 °; D- Dear Mr. Center: l 5a� v �r I OC✓ The New York State Department of Health Glens Falls Dist ' ice has received plans to replace onsite wastewater treatment systems(OWTS) at 86 and-88.Briwood.Circle within the .Forest-Park Mobile Horne Park, located in the Town of Queensbury,Warren County. The plans are approved with the following conditions: 1. THAT the engineer submits a signed certification stating that all systems are installed in conformance with the approved plans; and 2. THAT the applicant obtains all necessary permits from the Town of Queensbury prior to beginning construction. - • The purpose of Department of Health review is to verify compliance with the State Sanitary Code and in no way guarantees proper system design, installation or operation. If you have any questions or concerns please do not hesitate to contact me at(518) 793-3893. Sincerely, . • .-44-("4"Zej le'" 1""'"L3 Kristine L. Wheeler Public Health Engineer 2 Glens Falls District Office 77 Mohican St. . Glens Falls, NY 12801 • Cc: Anita Gabalski, NYSDOH GFDO • . American Residential Communities, Attn: Norma Rivera 4643 South Ulster St., Denver, CO 80237 Town of Queensbury Code Enforcement • • • HEALTH.NY.GOV facebook.com/NYSDOH twitter.com/HealthNYGov z 3 m c G ! z ,,, o Div ,t FF � a 7' g��� f fill H 99m IN�Q i Qy F$$y'p den Af as W 4 _ pp { m � q• ~t tag NaaJ., 0112 N O hitch End(Front) O _ cn xl > {xl N m E X °" C) m z 11 1 ! 0 v ° y m o rm Q � , loll 1 1 In1 1 ! mrnx1 ,--- _ __• {xI z Q 161 ! 1 _ _ 1 I ! 1 (40 ! ! { i © ,� a x{ m ;0 a lot 1 1 0 p m 1I M 1 f -� rm � � > D = ° Z lad 1 I 7 101 1 1 m m .� QA 1 i I 1 : lc! ! 1CO 55 _Z X1 M N ^( 4 a 5 z z c > '" -� > C m = m "'Safety First- All work to be conducted abiding by all industry safety rules & regulations 0 PROPERTIES I america"s home' ' Manufactured Home Drainage Inground Pier Footing manufactured home I Gravel bed under home 'h"per foot drop i 24"—.I r' i must have a crown to Insure. for drainage 10' skirting no water remains under home. yard E to gravel __________________________ ' into and `. !'. All grade material must be •,= r ,, compacted to a minimum concrete pier �' + � ` tlx�, LEGEND of 90%compaction. footing :, }" ' Width and depth ..? ,` �� . ,.I 0+®MO OM =Existing grade of foundation pier =' »R , determined by F-', ' , v;h = 6"minimum Graver manufacturers ' ; ' i :� =Rough graded set up manual —�— {: .�+ ; „„, to achieve Y2"per \1 — ..-- foot drainage TVendor Initials: Illustration 2 x Suitable material can replace gravel 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. �u C (D ry � c� C2 co O p 3�ID, �.3 ....mac 3, - 3 'C Vi m fD C tm/t re 2 a fnCD 0 ID CD $ cr O to cs m arm OC) �O d mm 0 !o CD � m � mci awe vsm � � O a0) c 0g umr � c5 ® (D rn @ m w m «cr 0 M. 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J F a F I d r _ �. --�.._.,a,..�,a_.N� �-- i 7 � ✓�r,�` ter - '� �7� - J ACE ENGINEERIN ! . .C. 169 Haviland Road, Queensbury, NY 12804 Phone-518-745-4400 Fax -518-792-8511 November 21, 201L Job#49335 Ms. Kristine Wheeler New York State Dept. of Health 77 Mohican Street Glens Falls,NY 12801 RE: Forest Park Community-Queensbury, Warren County ' =� 0 13 86 & 88 Briwood Circle-Replacement Septic System Gentlemen: This letter is to inform you that we inspected the completed replacement septic system for 86 & 88 Briwood Circle in the Forest Park Community on 11/9/2012. The septic system as installed was for a two (2) - 3 bedroom trailers and consisted of two (2) 1,000 gallon septic tanks and 800 sf.of absorption bed constructed with stone and 4-35 ft long perforated pipe laterals. The system conforms to the requirements of the approved replacement design drawings. Please call me if you have any questions or concerns. Sincerely, 64-1, Thomas R. 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