2024-0340 1 7,011 Office Use Only
MANUFACTURED HOME Permit#:
.fr TETI
Town ofQucensbury , Permit Fee:$ 50
742 Bay Road,Queensbury,NY 12804 ! I 11
P:518-751-8256 www.queensbury.net JUL p o 9 ��A'Qi
Rec Fee:$
J L
Invoice#:
Project Location: B014 br\wv,rTOWN OF QUEENSBURY Flood Zone? Y TYPE:
au ea
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Tax Map ID#: '88 Reviewed By: (C-41LAIO
Name of Park(if applicable): FOREST PARK MHC, LLC
PROJECT INFORMATION:
1. Proposed Date of Placement: 7/14/24
2. Approximate Value of Home:$50,000
3. Is the home NEW ✓ 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
✓❑Piers: 24" 48"
❑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): 5 :#of bedrooms: 3 ;#of bathrooms: 3
8. Additional heat source? No❑✓ Yes❑ If yes,choose one: gals fp*❑woodstove*❑ wood fp*❑
*Separate fireplace applications are required
9. Are there any other/existing buildings on the property? No; Yes ; Explain:
10. What is the water source? PUBLIC 0 PRIVATE WELL OTHER:
11. What type of wastewater system is on the parcel? SEWER PRIVATE SEPTIC 0
12. Do you need a septic permit application? No ✓ Yes❑(if yes,please submit separate septic application)
MANUFACTURED HOME INFORMATION:
(INFORMATION FOUND ON THE PLATE OR STICKER LOCATED IN THE HOME):
Insignia serial #: TBD
Name of Manufacturer: CHAMPION TOPEKA
Place approval #:
Model or component designation (New Home Only): 16X76H
Date of manufacture:
Manufactured Home Application Revised May 2024
•
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 QUEEENSBURY NY 12804
Cell Phone: ( ) Land Line: ( )518-745-7776
Email:
❑ 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:DIRTYWHITEBOY7=70@GMAIL.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
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 agr o the above:
PRINT NAME: g S Ch rarn0/
SIGNATURE: DATE:41_121___L
Manufactured Home Application Revised May 2024
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unoN DENT ON►AL FOR 1 O COS'Nip oc REAOIAREMENTS APOL E ANDN _ TT FOUNDATIONS REt E LOCAL BOPROFESSIONAL OR STRUCTURAL
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16' x76' Box
• PROPERTIES 1 americas home
24,24"Round Piers
X x x x x x 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" 99.5" 99.5"
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2' 6' 11' 18' 25' 32' 39' 46' 53' 60' 67' 74'
Community: Forest Park(NY) Site Numbe b014
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X Equalspier location-Note all measurements are to the centers of the piers. ApprovedTanyat y i I,Z 1 4 Telian �� ; `v R L i } 1
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[-Jul �;,..,-,t i Information reared based u on soil ca aci for the Site and calculations in accordance with the DAPIA a roved set manual. % v�W—• F prepared P bearing capacity performedPP factory up L1I � I`..,"
1••OWN OF Qr.UL ENSBURY
BUILDING :.,C '�:� .-`J.______I
,/Safety First- All work to be conducted abiding by all industry safety rules & regulations
0 PROPERTIES I americas home t� _ irl E
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Tie-Down 1 Anchoring L_ : - i
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RHP-approved anchoring systems: weti
• Tie Down Engineering Xi2 System CMG
• Oliver Technologies, Inc. l Ground Level
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• Minute Man "`
Stabilizer Plate � �� j
• Central Piers, Inc. ' ,/
Diagnal/Frame," i1Lr{.
Consult manufacturer's installation manual for requirements on frame �! .
and vertical sidewall anchoring, spaing and quantity of anchor points, Ground Anchor if
and method and configuration ..if" Lon itudinal �, ,.;u •;;re
t n of strapping. g `�'•��'�`•'�"`�`�
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.
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W 1dy C`k'73r..'21��"t1 ��"�� � } ,, dt �"'1i ��� �1
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° - v 'r • corners and when wrapped around the I-beam.
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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.
✓Safety First- All work to be conducted abiding by all industry safety rules& regulations ,
S PROPERTIES I americas home --1 111'
Manufactured Home Set - - ' 1.„/
Typical Footing and Pier D -p-- { '` ' µ esign i`'�n�� �°
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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
Y''' }.•, 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
v. . exceeding 2" in thickness.
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x x steel caps, x 8 x16 hardwood caps, or
• Y;: minimum 1/2" x 8"x16" concrete caps, or other. listed
°' materials. See§3285.304(b)(2) for cap requirements.
Note - steel caps must be protected by a minimum of a
_,, x'' V,, A��`I i� 10 mil coating of an exterior paint or an equivalent
,L 94�;: �� 9,1 71 corrosion resistant protection.
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Single open or closed concrete blocks 8" x 8 x 16"
Less than conforming to ASTM C-90 installed with 16" dimension
36" 4 ; r 41 perpendicular to the main I-bean frame. Open cells are
x> `��, placed vertically on footing. Mortar is not required
in height .�,,ZW + . unless specified in the manufacturers installation
, instructions or required by a registered professional
' "" *-40.4-; ° engineer or registered architect.
fu .,, t�� �, Avey'". '' Typical footing. Solid concrete or other product
�, � .. a -. e, Y 'p= approved for the purpose. Footing is placed on firm
-4. , .1- " ., undisturbed soil or on controlled fill, free of grass and
-4 x 4,, 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.
✓Safety First- All work to be conducted abiding by all industry safety rules & regulations
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0 PROPERTIES americas home' !—���_M x--, L `�`�
PR� ( : '�atL9^ 31 Y !E i
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Manufactured Home ) 1_Jiut. 09 .�.�: iil!
Drainage Tom oi=cLiEEi�lSBURY
BUILDINGw.CODES
"Do" and "Do Not" � __� . _�_.N._._� __
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.
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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 5
March 2019 For illustration purposes only- Must follow instruction of manufacturers installation manual, HUD CFR 24-3280, 3285, 3286 and local codes.
1Safety First- All work to be conducted abiding by all industry safety rules & regulations
0 PROPERTIES I america"s home(' r3 �-. rip
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for
into yard to graver-' . j Valk,i
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must be '' ,.,.. :,.:. ,...,,k;:;,k
All grade material ' p,, ;,
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compacted to a minimum concrete pier �- `�V`'k�'; `"``:;'-r = " ' -
of 90%compaction. footing n"<x . : { .,,. 4 , ;; a®�. .. =Existing grade
Width and depth ,: f. , :". , sf':
of foundation pier = :; _`_ "y P< ,i;,.,, `, :if ,,�,,,,li 7 o121, = 6 minimum Gravel*
ita6determined by z: a f }s F�:
manufacturers ""`�A ,,. =% =Rough graded
set upmanual ,,,:,,,,:,:::::,,N.,„:::,,,,,,,,,,,,,,'"
. �:��-� ,�g��;,, to achieve �h" per
'10�`=, ‘..,-- 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.
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183 Pitcher Road I Queensbury, NY 12804 Pitcher R
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518.745.7776 I forestpark@rhp.com
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