2013-002 ��` TOWN OF QUEENSBURY
742 Bay Road,Queensbuty,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20130002 Date Issued: Wednesday, January 23, 2013
This is to certify that work requested to be done as shown by Permit Number P20130002
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 By Order of Town Board
TOWN OF QUEENSBURY
6twx-004
Issuance of this Certificate of Occupancy DOES NOT relieve the property (DatiPO4
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.
TOWN OF QUEENSBURY
t 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130002 Application Number: A20130002
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. Type of Construction Value
Owner Address: ARC COMMUNITIES 14 LLC
PO BOX 61102 Mobile Home In Park $30,000.00
CHICAGO IL 60606-0000 Total Value $30,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
RAYMOND JONES
424-0508 P.O. BOX 702
BALLSTON SPA.NY 12020-0000
Plans&Specifications
2013-002 82 Briwood Circle
Mobile Home Eagle River Serial #ER 02779
Hud#NTA 1583765 Model 8051004 11/7/2012
$136.80 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,January 04, 2014
(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 nsb ;p F ' a January 04,2013
SIGNED BY f for the Town of Queensbury.
Director of Building&Code Enforcement
r P
• OFFICE USE ONLY •;
Name of Installer or Mobile Home Dealer: Cin—r— i� + .'k u
Address: P •6o)( OI I L.M c Phone: 61i '"Lv —aO ato
f-kW tc9
Complete information below found on a"Plate"or"Sticker"which is affixed to the mobile home:
✓ Insignia serial number. F kir- (
✓ Name of manufacturer: �� lP &e_A
✓ Plan Approval Number N TA- \ 5S 3 1 (c Le
✓ Model or Component Designation: 05 I Oq
` ( home only)
✓ Date of Manufacture: 1\ \1
1.YLa:r:l":!:YJ::tI:./:::IISi!:I:f:.•:!1!:!.:f�•:Y.n+tli�•il:•:tlsLt\!Li'u:l:/:�.Y:!:."..':.�..R!::.,f:i3Jll V:Vtltfl}:J�!:J�•i
'' AFFIDAVIT
Town of Queensbury State of New York s
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 4
of all proposed work to be done on the described premises and j
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.
Signature: �----
x
Owner, / er's Agent,A, hitect, Contractor
1u.'r.'JillXKKJul/`JiJ.l.JtsJ:JJ.J'.J✓.J.J.J.J•✓IJ.JIJIX+LYJiAa:J✓.ti.J�s✓.Jr.IfJililiw(JiwJiJIJiKKM:J•fJIKJFI4:JrJ
SPECIAL CONDITIONS OF PERMIT
By:
Code Enforcement Officer
Town of Queensbury• Community Development Office• 742 Bay Road, Queensbury, NY 12804
liksl.,, g - 4 )
Queensbury Building & Code Enforcement — Manufactured / Modular Final Inspection
Office No. (518) 761-8256 Arrive: am/pm Depart , --1 am/pm
Date Inspection request received: Inspector's Initials:
NAME: it r'1 6 PERMIT#: 13 -oo a
LOCATION: % ,P.' 6 12,E ( � DATE: 1—cad 3-'1_3
Manufactured Home V
Modular Home
Footings Foundation_ Backfill_ Framing—
Comments:
Yes No N/A
Foundation support,pier spacing,
7
Per manufacturer
Anchoring per manufacturer 2'from ends V�
Water line shut off
\(/*
Sewer line support @ 4 feet �
Heating Crossover[doublewide}off grd. ,f
Dryer vented outside /
Skirting ventilated 1 so.ft.Der 1.500 sq.ft. V�
Hot water relief valve piping outside V,
Deck, porches,steps,railing f
Fumace/hot water operating V
Garage Fire proofing L/
/
Fire Door/Door closers
Plumbing Fixture/3"Vent through roof[Modular] V
Foundation insulation[if applicable] V
Smoke/Carbon Monoxide Detectors/Interconnected
Final Electrical 1/
Variance required
/ 6
Data Plate okay V/
Manufactured HUD seal okay V
Warranty Seal after January 1,2006
/
Installers Warranty Seal V 'I Lc5 LC-3N) ' (.1 .;--- • '/ -
18"x 24"access or 22"x 30"attic access �t S
Vapor retarder under home 6 mil poly or other
911 Street number
Okay to issue C/C or CIO[Temp./Perm.]
40 k-\s_j\) .4- —
Model# 0 OS t. JT� Serial# 17.. OZ 11 NTS 1S ) l( 1
Manufacturer J^-ALAS: CZ...W6.1-- 401 41-5
Date of Manufacturer 11 I 1 \ \-1.--
L:1Pam Whiting120101Building Codes Forms1Manufactured Modular Final Inspection 03 04 10.doc
PERMIT PLOT PLAN
I HAVE PERSONALLY MEASURED THE DISTANCE
3 °72FROM THE PROPERTY LINES TO THE
PRO"*5ED ST U!' URE(S OR SIGN(S)
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I HAVE PERSONALLY MEASURED THE DISTANCE
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SIGNA U" DATE
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