2010-393 agoikkTOWN OF QUEENSBURY
too742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20100393 Date Issued: Friday, April 24, 2015
This is to certify that work requested to be done as shown by Permit Number P20100393
has been completed.
Location: 183 PITCHER Rd
Tax Map Number: 523400-308-014-0001-052-000-0000
Owner: FOREST PARK MHC, LLC
Applicant: LISA LAPOINTE AT 3 GREGWOOD CIRCLE
This structure may be occupied as a:
Mobile Home In Park By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property Ca40 4 )0t-'
owner of the responsibility for compliance with Site Plan, Variance, or
other issues and conditions as a result of approvals by the Planning Board Director of Building&Code Enforcement
or Zoning Board of Appeals.
404% TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100393 Application Number. A20100393
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: RAYMOND JONES
For property located at: 183 PITCHER Rd
in the Town of Queensbury,to construct 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: ARC COMMUNITIES 14, LLC Mobile Home In Park $25,000.00
900 Total Value $25,000.00
PO BOX 790830
SAN ANTONIO, TX 78279-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-393
3 Gregwood Circle- RAYMOND JONES - 1216 sq ft mobile home
$47.60 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,August 13, 2011
(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 the To Qu nsbur) ' F a _ + 1 st 13, 2010
SIGNED BY L-�-''��. `Y j \ for the Town of Queensbury.
Director of Building&Code Enforcement
C req Occd (h cj
OFFICE USE ONLY
TAX MAP NO. PERMIT NO. DATE ISSUED:
PERMIT FEE 1-177 APPROVALS: ZONING TOWN CLERK
MOBILE HOME— APPLICA TION FOR PERMIT:
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 Information Property Owner Information
Name: Q1 1 )(1)C inI k Name: Pe.C., Pro xr ys-,
Address: . .e.f,y d a Address: f$3 Pr i-1-ths4 Rol ,
a I ki-Dn ,Spa �l� I aOac C uEu,ro Gu,ty, / w/
Phone No. 51g�4/a / O5o8 Phone No. 578- 72/5 /77170
Parcel Information
Proposed Date of Placement: 1 LQ lip Property Location: 3 (-,regw cod W)C-6
rr--�� II Road,Street,Avenue
Name of Mobile Home Park: -Oies4 Par K , (if applicable) Tax Map Number:
Mobile Home Information Zoning Information
Approximate Value of Home: $ QS, 9 tA Zoning Classification:
New Home: Yes No Size of Property: ft. by ft.
Replacement Home: Yes No Existing buildings:
Size of Mobile Home: [p ft. by '-go ft. Setbacks: front yard ft. rear yard ft.
(izi J side yards ft. and ft.
Singlewide: Doublewide: See K 4. Tlc '
Number of Rooms: (exclude baths) 5 Accessory Building(s): circle
Number of Bedrooms: 3
Number of Bathrooms: Q Detached garage: 1-car 2-car car
Circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1-car 2-car car
Foundation Support: Storage building: Yes No
Type Size & Depth Other:
Piers
Runners X -2 Water Supply: well or municipal
Slab Is Septic Permit Required? Yes or No
Continued on page 2
0 Town of Queensbury- Community Development Office • 742 Bay Road, Queensbury, NY 12804
Revised March 2010
•
Name of Installer or Mobile Home Dealer: I ■ t! Sc h ( r of i b(s #e v
Address: ow-7 peen AP,�Nei l�IJ�Y 1 �('Whone: /g- 65-'OcQ '
Complete information below found on a "Plate" or"Sticker" which is affixed to the mobile home:
✓ Insignia serial number:
✓ Name of manufacturer:
✓ Plan Approval Number:
✓ Model or Component Designation:
(New home only)
✓ Date of Manufacture:
AFFIDAVIT
r i
Town of Queensbury State of New York
County of Warre.
1141 II
I swear that o the best of my knowledge and belief the
statements containe• 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.
Installer Warranty will be provide t time of Certificate of cupancy.
Signature:
# Owner, wn s Agent, Archit ct, Contractor
SPECIAL CONDITIONS OF PERMIT
By:
Code Enforcement Officer
gib Town of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804
T t\
Queensbury Building & Code Enforcement— Manufactured / Modular Final Inspection
Office No. (518)761-8256 Arrive: ►‘ i ,,. ._ .
Date Inspection request received: 1'4\15 Ins cr
Pector's 1n'
NAME: cfl�Z.L. PERMIT# Vb
LOCATION: ) OlY'2d Wood DATE: j\ 7� 2O
Manufactured Home �J
Modular Home
Footings_ Foundation_ Backfill_ Framing
Comments:
Yes No WA
Foundation support,pier spacing,
Per manufacturer
Anchoring per manufacturer 2'from ends
Water line shut off
Sewer line support @ 4 feet
Heating Crossover[doublewide?off grd.
Dryer vented outside
Skirting ventilated 1 sq.ft.per 1.500 sq.ft.
Hot water relief valve piping outside
Deck,porches,steps,railing
Furnace/hot water operating
Garage Fire proofing
Fire Door/Door closers
Plumbing Fixture/3"Vent through roof[Modular]
Foundation insulation[if applicable]
Smoke/Carbon Monoxide Detectors/Interconnected
Final Electrical
Variance required
Data Plate okay
Manufactured HUD seal okay
Warranty Seal after January 1,2006 \g�
Installers Warranty Seal
4C7
18'x 24"access or 22'x 30"attic access v
Vapor retarder under home 6 mil poly or other
911 Street number
Okay to issue CIC or CIO[Temp./Perm.]
Model# Serial#
Manufacturer
Date of Manufacturer
L:\Pam Whiting\2010\Building Codes Forms\ManufacturedMorn Feral Inspection 03 04 10.doc
Queensbury Building & Code Enforcement— Manufactured / Modular Final Inspection
Office No.(518)761-8256 Arrive: am/pm Depart f iam/pm
Date Inspection request received: Inspector's Initials: C/j•-t..1?
NAME: 1M .4:4•) PERMIT#. 2 -113
LOCATION: 3 C,�1.(-6. DATE: 1 1 ZL k LD
Manufactured Home - J
Modular Home
Footings_ Foundation_ Backfill_ Framing
Comments:
Yes No WA
Foundation support,pier�IP /
Per manufacturer ✓ V
Anchoring per manufacturer 2'from endsVZ
Water tine shut off
Sewer line support @ 4 feet ✓
Heating Crossover[doublewide)off grd. N,
Dryer vented outside IY
Skirting ventilated 1 so.ft.Der 1.500 so.ft.
Hot water relief valve piping outside V
Deck,porches,steps,railing
17 /
Furnace/hot water operating �.Furnace/hot
Garage Fire proofing -
Fire Door/Door closers A
Plumbing Fixture/3"Vent through roof[Modular] V
Foundation insulation[if applicable]
Smoke/Carbon Monoxide Detectors/Interconnected Y
Final ElectricalCAdV-1.sliVID
Variance required V
Data Plate okay
N/:
Manufactured HUD seal okay \...// q. N) �� /LI1L-3 c
Warranty Seal after January 1,2006 C
Installers Warranty Seali7
18'x 24"access or 22"x 30'attic access
Vapor retarder under home 6 mil poly or other / /
911 Street number
Okay to issue CIC or CIO[Temp.I Penn.] /0
j {�
Model# a51�"7106" ' Sena]# M1 1`2 ,\
Manufacturer f�f1, c , t f -D " C4 /
Date of Manufacturer c�' N,o
4�
L:1Pam Whiting120101Building Codes FonnslManufacturedModular Final Inspection 03 04 10.doc