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RC-000347-2016 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 s Community Development-Building&Codes (518)761-8256 CERTIFICATE OF OCCUPANCY Permit Number: RC-000347-2016 Date Issued: Friday, August 5, 2016 This is to certify that work requested to be done as shown by Permit Number RC-000347-2016 has been completed. Tax Map Number: 308.6-1-61 Location: 30 Petrie LN Owner: Queensbury Village, SAMUEL WAHNON Applicant: Lila Hanson This structure may be occupied as a:New Mobile Home(double-wide)28'x 55' By Order of Town Board Shed 12'x 16' TOWN OF QUEENSSBBURY 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. TOWN OF +QUEENSBURY : 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development - Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: RC-000347-2016 Tax Map No: 308.6-1-61 Permission is hereby granted to: Glens Falls Mobile For property located at: 30 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 filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance Type of Construction Owner Name: Queensbury Village Mobile Home $80,000.00 Owner Address: 1304 State Route 9 Total Value $80,000.00 Gansevoort,NY Contractor or Builder's Name 1 Address Electrical Inspection Agency Glens Falls Mobile 1304 State Route 9 Gansevoort,NY I2831 Plans&Specifications New Mobile Home(double-wide)28'x 55' Shed 12'x 16' $ 224.80 PERMIT FEE PAID -THIS PERMIT EXPIRES: Monday, .lune 5, 2017 (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 Town of ween ry; ride u , 016 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement Town of Queensbury Building & Codes Office Use Only MOBILE HOME APPLICATION Received: Tax Map ID: 308,G —1 — kc I A permit must be obtained before placement of mobile home on parcel. No Permit No.: RG � ??j—+ • 20 t inspections will be made until a valid building permit has been issued. Permit Fee: $ 2 2A ■ �eD� 1ny- � 1� Applicant �1 L4 S6 N, Property Owner e� A w1g 4'-'j0 Address Address 1 Bo U e* q b� KF I Phone01 Phone 7qa Contact Person for Building&Code Compliance: il� � ' � Day Phone: Name of Installer or L' Proposed Date of Placement A 1S ' Mobile Home Dealer � ,16f�.5 s 01156, Name of Mobile Horn, Park - v u 4 Address f�a E'c�Ik� Property Location Pi !o �UE� tub, +LR3 Phone n Tax Map ID — Complete information below found on a "Plate" or"Sticker"which is affixed to the mobile home: • Insignia serial number: • Name of Manufacturer: � r✓ r: • Place Approval Number: • Model or Component Designation: lle�,�ome �Date of Manufacture: J' ��6 2016 a % �?�;1!DING r,(-)Dgo Mobile Home Information Zoning Information Approximate Value of Home $ Ott Zoning New Home or Replacement Size of property ft. x ft. Size of Mobile Hom ft.by bg1 fft. Existing Building(s) Singlewide or oublewide Accessory Bldgs Number of Rooms(exclude bath) Storage Building(s) �5�) 1r 19. Number of Bedrooms Detached Garage —1 car _2 car —3 car Number of Bathrooms , Attached Garage _1 car — 2 car _3 car Gas Fireplace Setbacks Front Yard: YO feet Woodstove �!,}�, » Rear Yard: qQ feet Wood Fireplace Side Yard: - feet Foundation Support Size pepth Water Supply Well Piers Municipal Runners Septic Permit Required? Slab c 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- $10.00; Deposit-$100.00 (refunded when all items are complete) V 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. rQ n Print Name: --Gtr------- Signature: ly -�1� -- Owner,Owner's Agent,Contractor Date: Special Conditions of Permit: By: Code Enforcement Officer Town of Queensbury Building&Codes Mobile Home Permit 618-761-8256 I ' GRADE SURFACE DESIGN DATA: TOWARDS THE SWALE DESIGN FLOW- 700 GPD FOR TWO UNITS W/THREE BEDROOMS EACH (6 BR TOTAL) NgWSTANDARD FIXTURES, (1.6 GAF& 3 GPM MAX.) AN ELGIN SYSTEM IS PROPOSED AS A SUBSTITUTION TO PREVIOUSLY APPROVED SEEPAGE PITS 1-5 MINUTE PERCOLATION RATE W/APP RATE OF 1.7 G/SF o (28) B43 ELGIN MATS REQ'D, (4) ROWS OF 7 8 OUTLET DBOX W/SPEED LEVELERS 1750 GALL DC TANK LU rn 2lf o O m R ,jj J cn r- TOM OF-CUEtH LIJ a BUILDING DEPARTME T 0 I l Based on our limited examination, onipliance with our comments Shall not bP st ued as o indicating the plans and s ec'nc ons are in pp full compliance with the Buildi Codes o6 Cf New York State. Q z - LL No�� E L 1 p' 7' MIN ANCHORING Of MOBILE HOM V f RAME IS REQU RED PER 131fi 13'_6„ MANUFACTURERS S ECIFICATI NS LOTS ORIGINALLY APF CALCULATE ADDITIONi AND SIZE SHALLOW S 2 BR DOUBLE p CONSTRUCT SWALE RAIN INTENSITY, 1=2" WIDE MOBILE BETWEEN DOUBLE ADDITIONAL AREA FOF HOME in WIDE HOMES, GRADE 1960 SF LO SURFACE TO SWALE TIME = 1 HR RUNOFF: 2"X 1960S STORAGE CAPACITY 0 70' 70' TIME FOR FULL SWAL FOR A 12" DEEP SWA 12' APPENDIX 75A! o SETBACi 28' 28' I TREATMENT AREA TOPI v7 n TREATMENT AREA TO RE F_ r SEPTIC TANK TO WATER PARKING 24'X20' I I PARKING 24'X20' �'0 , 55.00' SHUT OFF SHUT OFF ACCESS ROAD B TOWN OF QUEPJS BUILDING & —reviewed By: y ELAN - DOUBLE WIDE LOT SCALE 1"= 20' Date: f ' INSTALL NO. 2_ 33 , .SATE OF NEWYORK DEPARTMENT OF STATE 1 ONE COMMERCE PLAZA j 99 WASHINGTON AVENUE ALBANY,NY 12231 INSTALL'ER'S WARRANTY SEAL THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE NEW MANUFACTURED(HUD CODE) ® RELOCATED MANUFACTURED{HUD CODE) A. Manufacturer's name:C�, " t Z A+16t^ -tic 4aave S B. HUD label number: G��lo PFS 1# q 10.7 -Serial nunlber.l —14- cx -t� z A C. Retailer's name: rt r�t o i ,..rl p ✓4Cil �-yY�1 f S c�.fi i D. Retailer's address: 1 3©L('7 -tf -- S-rvcl+vl' - sA.t'� 12- ' I E. Retailer's certification#:2 C—Z 22 3 7 Telephone#: 15-/9 F. Installer's name: !fw ,-y u e i J. "k n u es _ G. Installer's address: 6 J;)3sy ir1. /�,��, 12-ji3Q H. Installer's certification#: Telephone##: ,T 1 J 2_3 Z — '7 I. Date installed: 0 Municipality issuing building permit: (Cit `Tow Village) J. Customer name and physical address (911)where home is installed:73 +�S ca►F3 Newyork. By attaching this SEAL to this manufactured home,the undersigned Installer of this manufactured home warrants as follows: 1. That the installation of this manufactured home meets the standards of the New York State Uniform Fire Prevention and Building Code. 2. That the Installer is certified as an installer by the New York State Department of State. The foregoing warranties are in addition to and not in derogation of all other rights and privileges which the consumer may have under any other law or instrument.The foregoing warranties are in addition to,and not in limitation of or substitution for,any and all other warran- ties,express or implied,given or made by the Installer,whether contractually or by operation of law. ` Printed Name of Person Signing Seal 125 Ltc vvc::,^ Signature of Installer or Limited Installer: If you have a problem with your home,you should first contact your installer or retailer.If the problem is not resolved by the Installer or Retailer you can contact the Department of State of(518)47444073. DOS-1680(Rev.03/08) Yellow Copy—Department of State White Copy—Retain for Your Records Goldenrod Copy—Permitting Agency Seal—Affix to Home