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2015-258 eilak TOWN OF QUEENSBURY 742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201 Q mY Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20150258 Date Issued: Thursday, July 09, 2015 This is to certify that work requested to be done as shown by Permit Number P20150258 has been completed. Location: 183 PITCHER Rd Tax Map Number: 523400-308-014-0001-052-000-0000 Owner: FOREST PARK MHC, LLC Applicant: FOREST PARK MHC, LLC 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 /J / owner of the responsibility for compliance with Site Plan,Variance, or /Q( other issues and conditions as a result of approvals by the Planning Board Director of Building&Code nforcement or Zoning Board of Appeals. TOWN OF QUEENSBURY F4,10 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150258 Application Number: A20150258 Tax Map No: 523400-308-014-0001-052-000-0000 Permission is hereby granted to: FOREST PARK MHC. LLC 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: FOREST PARK MHC, LLC 31200 NORTHWESTERN Hwy Mobile Home In Park FARMINGTON HILLS MI 48834-00 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2015-258 Mobile Home from MA to be placed at 58 Briwood Circle 728 s.f. $87.36 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,June 22, 2016 (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 of Q ensb ;4 ► i •,�ay,June 22,2015 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement • Office Use Only MOBILE HOME APPLICATION Received. DATE: 69 1 KA/5 Tax Map ID I Permit No. .2'e `)_• 256 TAX MAP ID �° „'' �j1 18 201, Permit Fee F4 'fib Pd PROPERTY LOCATION: 58 br11�1ood ci refit. /� NAME OF MOBILE HOME PARK: �Orest Park I+'11-I-C ,� U CODE RY (� /� & CODES PROPOSED DATE OF PLACEMENT: ju')y V t 20/5 APPLICANT MQa 91 e. G((Anon on OWNER J LZ�'r"reAl 6 cl V,(,( era ADDRESS I 63 Pothey a ADDRESS `i 305 Wejerne).1 Park Mor-4/1 Oueenst9LAIrl Ny I a4VU/ QUe.n� esbl,&yj Ny wog 5 Jr PHONE ( I -Tr)l 6 PHONE 049)-1q,3- 1q2.2_ NAME OF INSTALLER OR MOBILE HOME DEALER e.JO(Y)JS TriAtkirl ADDRESS: ! VQ)bu k,✓, '2G Queensbu.(y Ny 10e0! PHONE (51g) 1g2-5-758 CONTACT PERSON FOR BUILDING&CODES COMPLIANCE M Q V14 PHONE: )LI5 I /`-' 3f3 € COMPLETE INFORMATION BELOW FOUND ON A"PLATE"OR"STICKER"WHICH IS AFFIXED TO THE MOBILE HOME Insignia serial number 001-000=H- 0115'1 OA Name of Manufacturer eikailIpion Place Approval Number Model or Component Designation _ NJ [A_ _ _ ((New home only) Date of Manufacture: 200`1 (!O1 2IOLo MOBILE HOME INFORMATION I ZONING INFORMATION Approximate Value of Home $ Zoning New Home or Replacement Size of property ft.by ft. Size of Mobile Home 1 Lj ft.by 52- ft. Existing buildings Singlewide or Doublewide 314 Accessory buildings Number of rooms(exclude bath) LI Storage buildings Number of Bedrooms oS Detached Garage 1 2 _3 Number of Bathrooms I Attached Garage 1 2 3 Gas Fireplace;Wcodstove or Wood Fireplace I� Setbacks Front yard: ft. iNti Rear yard: ft. Side yard: ft. Foundation Support Size Depth Water Supply Well: Piers Municipal: i/ Runners Slab Septic Permit Required? Yes ✓No 1 Town of Queensbury Building&Codes Mobile Home Application July 2014 Procedure for placing and occupying a mobile home or modular home: 1. Application is submitted and review: 2 copies of plot plan and layout must accompany application along with septic application (if needed) and fee. 2. Permit is issued— Permit card is placed on property 3. Footing forms are inspected before pouring concrete: Home is placed on foundation or piers 4. Arrange for electrical inspection—see "Certified Electrical form" on Town website 5. Septic Inspection, if needed 6. Final electrical Inspection 7. Stairs & platform covering door width and door swing with handrails on both sides of platform and stairs are required for all exterior doors. 8. Final inspection by Building & Codes Department 9. All mobile/manufactured housing must be anchored to the ground upon which they are site per manufacturer requirements. 10. Installer Warranty seal must be provided at the time of Certificate of Occupancy 11. If anchoring is not possible due to weather conditions or any other item, a Temporary Certificate of Occupancy will be issued; Fee -$10; Deposit$100.00 (refunded when all items are complete) 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 Building Code, the Zoning Ordinance, and all other laws pertaining to the proposed work shall be completed with, whether specified or not, and that such work is authorized by the owner. Installer Warranty will be provided at time of Certificate of Occupancy. Print Name: i/Y) I^ Date: l4 1 u1 I r5 Owner, •e , Contractor Signature: 1\-10, 81 e ( ckfr1 x'10 n Date: CO I U I I6 Special Conditions of Permit: By: Code Enforcement Officer 2 Town of Queensbury Building&Codes Mobile Home Application July 2014 Queensbury Building & Code Enforcement — Manufactured / Modular Final Inspection le, . 'Office No. (518)761-8256 Arrive: ek:' .art: • ��^ , am/. Date Inspection request received: `1161 2-c4 c Inspector's q � Initia ,41 NAME: NQS PC,VvPERMIT#: ' t 5- - 4-)6,) PERMIT 5(8 \EY-1\ t(Y'\ LA Y L)0DATE: I-191 ZQ\r Manufactured Home Modular Home Footings_ Foundation_ Backfill Framing— Comments: Yes No N/A Foundation support, pier spacing,Per manufacturer /\// JfAnchoring per manufacturer 2'from ends Water line shut off X065 - b(c q Sewer line support @ 4 feet Heating Crossover[doublewide}off grd. / 1 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 VVV / 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 L` Warranty Seal after January 1,2006 Y/ ( j Installers Warranty Seal v 18"x 24"access or 22"x 30"attic access ..----r,„ \� Vapor retarder under home 6 mil poly or other %,1 — \� c 911 Street number Okay to issue C/C or C/O[Temp./Perm.] Model#7�.Dc->1I v4tc,c)FiiL Serial# OC --cC•.c —N-0f,"l,5 uC>W Manufacturer C_\A\ AC� i2__CA?Cr Date of Manufacturer ‘ --7-1--k"C.`'C L:\Pam Whiting\2010\Building Codes Forms Manufactured_Modular Final lnspection_03 04 10.doc • TOWN OF QUEENSBURY G' NOTICE BUILDING DEPARTMENT ANCHORING OF MOBILE NOME Based on our limited examination,compliance — FRAME IS REQUIRED PER with our comments shall not be construed as indicating the plans and specifications are in MANUFACTURERS SPECIFICATIONS full compliance with the Building Codes of New York State. 51 N � TOWN OF QUEENSBURY BUILDING & CODES PT. 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