2012-395 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120395 Application Number: x20120395
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: ARC COMMUNITIES 14 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. Tyne of Construction Value
Owner Address: FOREST PARK MHC, LLC Mobile Home In Park $30,000.00
31200 NORTHWESTERN Hwy Total Value $30,000.00
FARMINGTON HILLS MI 48834-0(
Contractor or Builders Name /Address Electrical Inspection Agency
Plans&Specifications
2012-395
1,216 sq ft Manufactured Home at 95 GREGWOOD Circle
7/24/2012 Marlette,Model #8016LDMK Serial#LEW 110762PA
$145.92 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,August 21,2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Tuesday,August 21,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
Fors 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120395 Date Issued: Thursday, September 27, 2012
This is to certify that work requested to be done as shown by Permit Number P20120395
has been completed.
Location: 183 PITCHER Rd
Tax Map Number: 523400-308-014-0001-052-000-0000
Owner: ARC COMMUNITIES 14 LLC
Applicant: ARC COMMUNITIES 14 LLC
This structure may be occupied as a:
Mobile Home In Park —! 5 3 rets wood `'1 r'e e. By Order of Town Board
ga,fi TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property � /owner of the responsibility for compliance with Site Plan, Variance, or4 ,g
other issues and conditions as a result of approvals by the Planning Board Director of Building&Code Enforcement
or Zoning Board of Appeals.
�- -'-----------=___'%—
OFFICE USE ONLY r; �, ((f r`� n M N
So S. ly- t-5 j ,[ I -Date
TAX MAP NO.�^ PERMIT NO. r – DATE ISSUED:
PERMIT FEE / T6VAPPROVALS: ZONING TOWN CLERK AUSt'I
IL
TC. nr
BUILDI,4 a L,OOES
MOBILE HOME -APPLICATION FOR PERMIT:
A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a
valid building permit has been issued.
Applicant Information Property OwnernInformation)
Name: mY onj So nts Name: ARO
R ,. pro ri
Address: {�U BOX Ina Address: I Ptirhex prof-pricy
Pia I,Won_Spa , rnik wan 1) flILPet( ry , nr• ic2wq
Phone No. 61$ "q&4- b CO Fr Phone No. St K- 174/ 797(e
Parcel Information r� //�� J
Proposed Date of Placement: It% I a Property Location: sVt5 C rea ( 5rrr.le
-Forest-
- '/ Road, treet, venue
Name of Mobile Home Park: Forest V . (if applicable) Tax Map Number:
Mobile Home Information Zoning Information
Approximate Value of Home: $ Zoning Classification:
New Home: Yes ❑No Size of Property: ft. by ft.
Replacement Home: ❑Yes ❑No Existing buildings:
Size of Mobile Home: I tt ft. by 11 L. ft Setbacks: front yard ft. rear yard ft.
side yards ft.and ft.
Singlewide: X Doublewide:
Number of Rooms:(exclude baths) 5 Accessory Building(s):
Number of Bedrooms:
Number of Bathrooms: Detached garage:01-car 02car ❑—car
0 Gas Fireplace 0 Woodstove 0 Wood Fireplace Attached garage: ❑1-car 02-car 0_car
Foundation Support: Storage building: DYes ❑No
Type Size & Depth Other.
Piers
Runners 3CI x(75Water Supply: ❑Well WMunicipal
Slab Is Septic Permit Required? El yes o
Continued on page 2
_ -Town of Queensbury• Community Development Office• 742 Bay Road, Queensvury, zv r .ZOL M
.
Name of Installer or
Mobile Home Dealer q\ �1)v n-s. f3t4
Address: .41 C�ceef eld Ate,&11 I Jrhone: ,6"-)S— 5-69 0
fr- i: '
Complete information below found on a'Plate"or*Sticker which is affixed to the mobile home:
✓ Insignia serial number.
✓ Name of manufacturer. rnarld-le
✓ Plan Approval Number.
✓ Model or Component Designation: DmK1W-11.03 q-
(New hornonly)
✓ Date of Manufacture:
AFFIDAVIT
Town of Queensbury State of New York
i County of Warren
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 y
that all provisions of the BUILDING CODE, the ZONING
ORDINANCE, and all other laws pertaining to the proposed work
S shall be complied with, whether specified or not, and that such y
work is authorized by the owne
Signature:
0 e , is Agent, • 'ect,Contractor c
SPECIAL CONDPITONS OF PERMIT
By:
Code Enforcement Officer
fez Town of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804
s €°.
I Lescia( N3
Queensbury Building & Code Enforcement— Manufactured / Modular Fina lnnspection
Office No. (518)761-8256 - Arrive: am/. s - ._rt 2\t ' am/pm
Date Inspection request/� received: Inspector's Initials: _LL l ?
NAME: '$'R c C1/4‘1-16)/
fat PQ lt.2 PERMIT#: R —395
LOCATION: I .5 !1�-16 /fir f0 DATE / -d,�--Ini
Manufactured Home %I J\
Modular Home p�
Footings_ Foundation_ Backfill_ Framing
Comments:
Yes No NIA
Foundation support,pier spacing,
Per manufacturer
Anchoring per manufacturer 2'from ends
Water line shut off / j
Sewer line support @ 4 feet t�//
Heating Crossover[doublewide)off grd.
Dryer vented outside
Skirting ventilated 1 so.ft.oer 1.500 so.ft. Tir
Hot water relief valve piping outside /
Deck,porches,steps, railing V
Fumace/hot water operating 1/1/Garage Fee proofing VVV .
Fire Door/Door closers
Plumbing Fixture/3'Vent through roof[Modular]
Foundation insulation ff applicable] V
Smoke/Carbon Monoxide Detectors/interconnected f/
Anal Electrical 7 /
Variance required V / /
Data Plate okay // V
Manufactured HUD seal okay V.
Warranty Seal after January 1,2006 VVVf/
Installers Warranty Seal ,V/
18'x 24'access or 22'x 30'attic access Y
Vapor retarder under home 6 ma poly or other /
911 Street number V
Okay to issue C/C or CIO(Temp./Penn.] / np ,
Model# ate / _,% V - '-I# �Iweet 01(/Q'f b"
Manufacturer
Date of Manufacturer 1 `LA(,VI-,
L:1Pam Whiting120101Building Codes Forms Manufactured_Modular Final Inspection 03 04 10.doc