RC-000209-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-000209-2016 Date Issued: Thursday, September 8, 2016
This is to certify that work requested to be done as shown by Permit Number RC-000209-2016
has been completed.
Tax Map Number: 308.6-1-61
Location: 19 Petrie LN
Owner: SAMUEL WAHNON
Applicant: Charles Sperbeck
This structure may be occupied as a:New Mobile Home in Park
1792 s.E Champion By Order of Town Board
TOWN OF QUEENNSSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
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TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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�I �iul II a Community Development-Building& Codes (518) 761,-8256
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BUILDING G PERMIT"
Permit umber: RC-000209-2416
Tax Map No: 308.6-1-61
Permission is hereby granted to: Glens Falls Mobile
For property located at: 19 Petrie LN
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 riled and approved and in compliance with the NYS Uniform.
Building Codes and the Queensbury Zoning Ordinance
Type of Construction
Owner Name: SAMUEL WAHNON Mobile Home $80,000.00
Owner Address: 1304 Route 9 Total Value $80,000.00
Gansevoort,NY 12831
Contractor or Builder's Name/Address Electrical Inspection Agency
Clens Falls Mobile
1304 State Route 9
Gansevoort,NY 12831
Plans&Specifications
New Mobile Home in Park.
1792 s.f.Champion
$ 215.04 PERMIT FEE PAID -THIS PERMIT EXPIRES: Monday, April 10,2017
(If a longer period is rewired,an application for an extension must be made to the code Enforcement(Meer
of the Town of Queensbury before the expiration date.)
Bated at the Town ;cn:p Fr" pri l l 5, 201 f
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use and
MOBILE HOME APPLICATION Received:
Tax Map ID:
A permit must be obtained before placement of mobile home on parcel. No Permit No.: tr–-000,Los - ZZ I �0
inspections will be made until a valid building permit has been issued, Permit Fee: 15. OA 1,1'j, �'k-b
Applicant Property Owner
Address lcf _"P '4? Address Ft)4
Phone
Phone
ell1
IK'()
Contact Person for Building&Code Compliance: Day Phone:
Name of Installer or Proposed Date of Placement ap
Mobile Home Dealer Name of Mobile Home Park
Address Property Location Lr>-i—,
Phone Tax Map ID 12-- 6,
Complete information below found on a "Plate" or"Sticker"which is affixed to the mobile home:
Insignia sedall number:
C" E 0 �'v#
Name of Manufacturer:
• Place Approval Number: �rtii;'i° 1. 4 2 016
► Model or Component Designation: w home only)
V
W 1, y
(jr L
Date of Manufacture,: IMT Of
BULDINGt ODES
Mobile Home Information Zoning Information
Approximate Value of Home $
b er c Zoning
New Home or Replacement OP
V Size of property h, x ft
146&)
Size of Mobile Home ft. by `1 ft. Existing Building(s)
Single,wide or Doublewide p VAccessory Bldgs.
Number of Rooms(exclude bath) Storage Buildings)
Number of Bedrooms w Detached Garage —1 car 2 car 3 car
Number of Bathrooms Attached Garage —1 car 2 car 3 car
Gas,Fireplace Setbacks Front Yard: feet
WoodstoveRear Yard: feet
Wood Fireplace Side Yard:
feet
Foundation Support Size Depth Water Supply Well,
Piers Municipal
Runners Septic Permit Required?
Stab 22�
Town of Queensbury Building&Codes Mobile Home Permit 518-761-8256
Procedure for placing and occupying a mobile home or modular home:
1. Application is submitted and reviewed: 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 the Town's website
5. Septic Inspection, if needed
6. Final Electrical Inspection
7, Stairs and 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 sited 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-
$110.00; Deposit-$19191.00(refunded when all items are complete)
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:
Signature:
Owned s er contractor
Date:
Special Conditions of Permit:
By: Code Enforcement Officer
Town of Queensbury Building&Codes Mobile Home Permit 518-761-8256