2013-110 411110.0. TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
4111i.
Q ry,
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20130110 Date Issued: Monday, April 15, 2013
This is to certify that work requested to be done as shown by Permit Number P20130110
has been completed.
Location: 31 BURCH Rd
Tax Map Number: 523400-308-006-0001-003-000-0000
Owner: TERRIE LEE REED
Applicant: TERRIE LEE REED
This structure may be occupied as a:
Mobile Home Out of Park By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property l
4'
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 Enforce 'nt
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
e.14. "14. 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
FON
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130110 Application Number: A20130110
Tax Map No: 523400-308-006-0001-003-000-0000
Permission is hereby granted to: TERRIE LEE REED
For property located at: 31 BURCH 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: TERRIE LEE REED Mobile Home Out of Park $15,000.00
31 BURCH Rd Total Value
QUEENSBURY NY 12804-0000 $15,000.00
Contractor or Builder's Name /Address Electrical Inspection Agency
ML CONTRACTING
798-0317 OR 955-8168
34 WARREN Ln
OUEENSBURY NY 12804-0000
Plans&Specifications
2013-110 2004 Marle/Shult Model 7014-1633, Serial # t030681; Mobile Home 980 sq ft
Res. Septic Alteration all part of installation
$117.60 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,March 29,2014
(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 Town of Queensbu A Fr'. .y,March 29, 2013 •
SIGNED BY for the Town of Queensbury.
Director of Building& ode E`orcement
- cf.\g. 19 -On
plcc •
y _
TOWN BOARD APPLICATION FOR PLACING A ,;V
MOBILE HOME OUTSIDE OFA MOBILE HOME COURHT: l 7013''AFD . r
This application for a Mobile Home Permit shall be accompanied by a plot plan ' CRekS'.9/My
drawn reasonably to scale showing all dimensions, the size of the lot, the location on',., ""'��� „,
the lot of the Mobile Home, the water supply and sewage system. If the applicant is not the owner of the
premises, then the application must be accompanied by the written acknowledged consent the owner.
Applicant Information Property Owner Information
Name: ,f.evC,e�,/// Name: /e/I.Av /Geed
Address: Address: 7 0p6� d
oitesT,9/ed
QLD e,9s B y N f/ /macro V
Phone No: Phone No: 3 3 Ye6
Parcel Information
Property Location: 3/ Ago/ Oilk-k-ttsed, Tax Map Number: gns, 6 -/
Road,Street,Avbnue
Mobile Home Information
Approximate Value of Home: $ /55 a-0 of fti,y New Home: Yes No
Replacement Home: Yes 6o) Size of Mobile Home: y
l ft. by ft.
Singlewide: yeS
Doublewide: Year: 02 00 V Make: /n/4/e L *l;Lr
Model: / e y r
/ Serial # L C(. V
State fully the reasons for this request:
41647 7-0 ,nZ'Ve my //0'1e / 77 /94/ 7'7 /)/t: P,e
Admftt3.
Applicant's Signature ate
Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804
Revised March 2010
AFFIDAVIT
Town of Queensbury State of New York
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
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: �� ^� p
NB_Owner, Agent, Architect, Contractor to
♦:1M.NJ.J:f:Nf:f:Nf:J.'J.J-f.J.f✓:J.f:f.f.J.f.'u:f.f.J.J.J.f.f.fy:J:fJ.f.J.f.f.J.J.f.J.J.I.J.f:f:f:f:i1M.fiJif+l:lY'1JJ444tf:f:Jt1Cl:J:J:f:f
FOR TOWN USE ONLY
Report of the investigation of the Zoning Administrator and recommendations:
APPROVED:
DISAPPROVED:
OTHER RECOMMENDATIONS:
ACTION OF THE TOWN BOARD:
APPROVED:
DISAPPROVED:
OTHER RECOMMENDATIONS:
By Resolution Number: of the Town Board of the Town of Queensbury,
Warren County, New York.
Dated this day of , 20
Town Clerk, Town of Queensbury
la Town of Queensbury• Community Development Office - 742 Bay Road, Queensbury, NY 12804
Revised March 2010
r Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
AFFIDAVIT
TOWN OF QUEENSBURY STATE OF NEW YORK
COUNTY OF WARREN
I swear that the following used mobile home that will be transported into the Town of Queensbury
for placement will have the following:
a. A building permit approved and issued
b. Meet all zoning requirements
c. Mobile Home's HUD sticker affixed to the mobile home
d. Meet HUD requirements for the Middle Zone.
As the person responsible for the transport and placement of this mobile home, I accept total
responsibility for removal of the mobile home from the Town of Queensbury if it does not meet the
requirements for placement.
4(Signature: .t 7_ .� 4—A-1-----11 )3
Mobile H "e/Ow r, w► ;i's Agent, Mobile Home Contractor Date
Signature:
Town of u nsbuly C.• - Enforcement is Date
Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804
if7, tp 6P13H fp;
TOWN BOARD APPLICATION FOR PLACING A
MOBILE HOME OUTSIDE OF A MOBILE HOME COURT:
This application for a Mobile Home Permit shall be accompanied by a plot plan
drawn reasonably to scale showing all dimensions, the size of the lot, the location on
the lot of the Mobile Home, the water supply and sewage system. If the applicant is not the owner of the
premises, then the application must be accompanied by the written acknowledged consent of the owner.
Applicant Information Property Owner Information
Name: 1.6X,e y ec.o/ Name: /e/e�e5/ /teed
Address: c. Address: ? //l0,6d,(a
o/resr��eK)
Ql� ee/) lay A/1 / '&
Phone No: Phone No: 0 3 6 -- ,3 ciC)
Parcel Information
Property Location: .3/ J3C1,(/t /'1/� (l ,f,(/&(JS� Tax Map Number: .4(3, (� -
Road, Street,Avenue
Mobile Home Information
Approximate Value of Home: $ /5; OW) a ui.x New Home: Yes No
Replacement Home: Yes No ' Size of Mobile Home: /4/ ft. by /26 ft.
Singlewide: ye5 Doublewide: Year: 2O V Make: ft/A LL-J *, f-
Model: L' ! / ' Serial #
State fully the reasons for this request:
�cJCr'/)7 70 f) j/e � ''tee .40,9C/< 1&
DdAr7(/--- --1 Qt.u AReCk_,;•,( •.
Applicant's Signature late
. 4 Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
Revised March 2010
A
•
AFFIDAVIT
Town of Queensbury State of New York
County of Warren
is
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 complied with, whether specified or not, and that such
work is authorized by the owner. 3
r
Si nature: / Ate ? �
- g
Owner, Agent, Architect, Contractor D to
FOR TOWN USE ONLY
Report of the investigation of the Zoning Administrator and recommendations:
APPROVED:
DISAPPROVED:
OTHER RECOMMENDATIONS:
ACTION OF THE TOWN BOARD:
APPROVED:
DISAPPROVED:
OTHER RECOMMENDATIONS:
By Resolution Number: of the Town Board of the Town of Queensbury,
Warren County, New York.
Dated this day of , 20
Town Clerk, Town of Queensbury
Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804
Revised March 2010
Community Development Office
;{ Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
AFFIDAVIT
TOWN OF QUEENSBURY STATE OF NEW YORK
COUNTY OF WARREN
I swear that the following used mobile home that will be transported into the Town of Queensbury
for placement will have the following:
a. A building permit approved and issued
b. Meet all zoning requirements
c. Mobile Home's HUD sticker affixed to the mobile home
d. Meet HUD requirements for the Middle Zone.
As the person responsible for the transport and placement of this mobile home, I accept total
responsibility for removal of the mobile home from the Town of Queensbury if it does not meet the
requirements for placement.
Signature: L(' i t�.c -"(C i' Le I IP� 13
Mobile Home Owner, Owner's Agent, Mobile Home Contractor Date
Signature:
Town of Queensbury Code Enforcement Officer Date
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 L013
3
M/
Office Use Only #4,1lJ 211I3
TAX MAP NO.3 0 g ((I-I.3 PERMIT NO. ! 3 'II C PERMIT FEE' '
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: / eXXV 'QQcS INSTALLER: L- C 0/77-/fAc'.T/A/C
ADDRESS: 41 0.b!! o d/4.,d ADDRESS: 3'/ 1 *z, r&7 Z•47/,e
PHONE NOS. 3 b - 3 v d O PHONE NOS. W.:9-63//7 9,53-476s)
LOCATION OF INSTALLATION: ,/ Aloof /cD/J IUL
, t�=GV-�BLIey /Vy �?Yd`f
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED? Au
1981 -1991 X 130 = SPA OR HOT TUBA/0
1992-present X 110 ao2O INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING X STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND X LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS / - PER MIINUTE PER INCH[mpil (Test to be completed by a licensed professional
engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or
architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: /600 GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirlpool tub.
SYSTEM TYPE:
ti'ABSORPTION FIELD(WITH NO.2 STONE) Total length ca?00 ft. Each trench t2C1 , X 5-0
o SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL
INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or approval
granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or
circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this application and agree to
abide by these and all requirements of the Town of Qu ensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sewage Disposal Ordinance. j codes(@oueensburv.net
1'� /Pt �c VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible to www.queensburv.net
CASHIER'S DEPARTMENT - TOWN OF QUEENSBURY
BUILDING & CODES
✓ Code No. Title Fee Fee Reason for Refund Staff
Collected Refunded Initials
01-51570 (210) Demolition Permit
01-52122 (211) Sewer Variance
01-52555 (212) Building Permit
01-52555 (212) Sign Permit
01-52555 (212) Septic Permit
01-52655 (230) Miscellaneous
PLANNING &ZONING
01-52110 (220) Zoning Fees
01-52115 (221) Planning Fees
01-52115 (221) Site Plan Review
01-52115 (221) Subdivision
01-380 (222) Technical Assistance
Invoice #
01-52655 (223) Miscellaneous
01-52002-0061 Recreation
(224) Assessments
FIRE MARSHAL
01-51560 (190) Public Safety
01-52655 (230) Minor Sales
NAME &ADDRESS OF CUSTOMER PROJECT NAME/ NUMBER
' FFICE USE ONLY
Cash C # Total Fee Total Fee
�15 Collected _ Refunded
Town Clerk/ _ Date
Deputes Signature
Prepared by: O Building & Codes O Planning O Zoning O Fire Marshal
Original (Town Clerk) Canary (Town Clerk) Pink (Customer) Gold (Return to Dept. checked above)
CASHIER'S DEPARTMENT - TOWN OF QUEENSBURY
&CODES
Code No. Title Fee Fee Reason for Refund Staff
Collected Refunded Initials _
01-51570 (210) Demolition Permit
01-52122 (211) Sewer Variance
01-52555 (212) Building Permit
01-52555 (212) Sign Permit
01-52555 (212) Septic Permit
01-52655 (230) Miscellaneous
PLANNING & ZONING
01-52110 (220) Zoning Fees
01-52115 (221) Planning Fees
01-52115 (221) Site Plan Review
01-52115 (221) Subdivision
01-380 (222) Technical Assistance
Invoice #
01-52655 (223) Miscellaneous
01-52002-0061 Recreation
(224) Assessments
FIRE MARSHAL
01-51560 (190) Public Safety
01-52655 (230) Minor Sales
NAME &ADDRESS OF CUSTOMER PROJECT NAME / NUMBER
,/ OFFICE USE ONLY '
Cash Check # _ Total Fee _ Total Fee
t ' Collected / .`.' 'I- f Lr) Refunded
Town Clerk/ Date
Deputy's Signature --
Prepared by: OBuilding &Codes O Planning O Zoning O Fire Marshal
Original (Town Clerk) Canary (Town Clerk) Pink (Customer) Gold (Return to Dept. checked above)
`D —/ fr
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: /3
Queensbury Building &Code Enforcement Arrive: am/ Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ,, "'
NAME: PERMIT NO.: 3 - /10
LOCATION: 3 L (,�.rc4-. INSPECT ON: #),1171-0/ 3
RECHECK:
r,— Comments and/or diagram
Soil Type:`8a .d'/ Loam/Clay
Type of Water: Municipal/ Well Water
Waterline separation distance ft.
Well separation distance ')___ _ft.
Other wells: v ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length ��w ft.
Length of each trench 'c Z ft.
Depth of trenches "L ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tankJ
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: T N —
End Cap N
Inlet/Outlet Pipes &Baffles Y N
Manholes 12"or less below grade _Y_N
[provide extension collar if Yes] Y N
Location/ Separations 1
Foundation to tank % Aft.
Foundation to absorption ft.
Separation of Pits ft. i
Conforms as per Pl n N
Engineer Report an As-i3 ' AL Y N �'` y �
ETU Maintenance on ct _Y_ N 1
provided
Location of System of roperty:
Front Rear Left Side Right Side Middle Front Middle Rear
stem Use S s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L•\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report.03 29 10.doc
Queensbury Building & Code Enforcement-- Manufactured / Modular - nal Inspection
Office No. (518) 761-8256 Arrive: 11%I ' .=it: a pi
Date Inspection request received: Inspector's Initials: �iiv>�.t
NAME: R eF D PERMIT* \3-\ \C C
r
LOCATION: cT3\ )�C-V-\ W) DATE: 14 - ri..7 \ 3
Manufactured Home
Modular Homez
Footings Foundation_ Backfill_ Framing
Comments:
Yes No WA
Foundation support,pier spacing,
Per manufacturer4
Anchoring per manufacturer 2'from ends
Water line shut off
Sewer line support @ 4 feet
Heating Crossover[doublewide)off grd.
Dryer vented outside
* Skirting ventilated 1 so.ft.per 1,500 sq.ft. ;17/
Hot water relief valve piping outside
Deck,porches,steps,railing //t/ .
Fumace/hot water operating
Garage Fire proofing /4/
Fire Door/Door closers ,./,✓
Plumbing Fixture/3"Vent through roof[Modular]
Foundation insulation[if applicable]
Smoke/Carbon Monoxide Detectors/Interconnected
.)k Final Electrical
Variance required
Data Plate okay /7/
Manufactured HUD seal okay
Warranty Seal after January 1,2006 /(//.17
Installers Warranty Seal
18"x 24"access or 22"x 30"attic access f
Vapor retarder under home 6 mil poly or other V /
::: s:::ror
CIO[Temp./Perm.]
1-)� \ \) -
R. Model# --7()k -l b9 3 Serial# 1 Cy 03 \,
Manufacturer t-'\'ac [3C-\--VA�
Date of Manufacturer C -15-z_u`c3
L:1Pam Whiting120101Building Codes Forms'Manufactured_Modular Final Inspection_03 04 10.doc
1huA,bc g - 16
Queensbury Building & Code Enforcement— Manufactured / Modu ar Final Ilpection
Office No. (518)761-8256 Arrive: ` - part: , =
Date Inspection request received: Inspector's Initia
NAME: (J r r) ( Se-8 PERMIT • / 3-110
LOCATION: 3J LUL6 -Ni`C JC� DATE: /—// "/ 3
Manufactured Home Y
Modular Home
Footings_ Foundation_ Backfill_ Framing
Comments:
Yes o WA
Foundation support,pier spacing,
Per manufacturer
Anchoring per manufacturer 2'from ends
Water line shut off
Sewer line support @ 4 feet
Heating Crossover[doublewide}off grd.
Dryer vented outside
Skirting ventilated 1 sq.ft.per 1,500 sq.ft. V.
/
Hot water relief valve piping outside
Deck,porches,steps,railing ` Pk" �� 6_>
Fumace/hot water operating
Garage Fire proofing
Fire Door/Door closers
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
Warranty Seal after January 1,2006
Installers Warranty Seal
18"x 24"access or 22"x 30"attic access k - CAL
Vapor retarder under home 6 mil poly or other
911 Street number
Okay to issue C/C or CIO[Temp.I Perm.]
Model# WQ'lI Serial#
1�,
Manufacturer t. �
Date of Manufacturer
L:\Pam Whiting120101Building Codes Forms\Manufadured_Modular Final Inspection 03 04 10.doc
INSTALL NO. 17893 STATE OF NEW YORK
DEPARTMENT OF STATE
ONE COMMERCE PLAZA
99 WASHINGTON AVENUE
ALBANY,NY 12231
INSTALLER'S WARRANTY SEAL
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE
❑ NEW MANUFAQITURED(HUD CODE) J RELOCATED MANUFACTURED(HUD CODE)
A. Manufacturer's name:/r -fl-E
B. HUD label number. W779 449146 Serial number: 133 OCt
C. Retailer's name:
D. Retailer's address: 1 T /JA
E. Retailer's certification#: Telephone#:
F. Installer's name: - /4,44401:40t � lr+
G Installer's address: 94,Ed/'"' k. � 4)dk;',t
H. Installer's certification#: d f'T'�1? Telephone#: e 727,Y'73 cY
1. Date installed: ye/.3 Municipality issuing building permit: re sjr
(city;Town, la
ge)
J. Customer name and physical address (911)where home is installed: -rg.y 4Ej(�
1/ J.*ftt.N 171, 041 4,60(4. ,New York. /04.1.)/4
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,w her contractually or by operation of law.
Printed Name of Person Signing Seal: llf&url/c¢
Signature of Installer or
Limited Installer:
If you have a problem wit 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 at(518)474-4073.
DOS-1680(Rev.03/09)
Yellow Copy—Department of State White Copy—Retain for Your Records Goldenrod Copy—Permitting Agency Seal—Affix to Home
i tt e .S 1-3 (3e,,,)
Foundation Inspection Report
Office No.(518)761-8256 Date Inspectio n .
QueensburyBuilding&Code Enforcement Arrive: l% :1 . i , �" Ad/ �
742 Bay Rd.,Queensbury,NY 12804 Inspector's Inti= 04.- i
"ii
NAME: R ed PERMIT#: 13-- 11 o
LOCATION: 3i L'S(,LT'C'J Rd INSPECT ON: 4i— ..-/ '�
TYPE OF STRUCTURE: N' 0 koi 1 p }--1e,M ee
Comments
Y
Footings Z— -V‘3 il ‘ F ‘2-
Piers
Monolithic Slab
Reinforcement in Place t
�z,
The contractor is responsible for — C t 41 0 ,v
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site.
Foundation/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofing
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L.:WBullding&Codes Forms\Buliding&Codes\Inspection Forms\Foundadon Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
11 '-ou
Queensbury Building & Code Enforcement — Manufactured I Modular Final Inspection
Y i
Office No. (518) 761-8256 Arrive: ` 1_I= giD..-.)•. Q 1 v �
Date Inspection request received: Inspector's In .< ."
NAME: (LLC ) K-V--� PERMIT* YF 11JQ\ an 13 4 to
LOCATION: 7_1 L.3 0001_RIJ ) V v -\ DATE: C3) "2_.(i.)-\
Manufactured Home
Modular Home
Footings_ Foundation_ Backfill_ Framing
Comments:
Yes No WA
Foundation support, pier spacing,
Per manufacturer
Anchoring per manufacturer 2'from ends
Water line shut off
Sewer line support @ 4 feet
Heating Crossover[doublewide}off grd.
Dryer vented outside
Skirting ventilated 1 sq.ft.per 1.500 sq.ft.
Hot water relief valve piping outside
Deck,porches,steps, railing
Fumace/hot water operating
Garage Fire proofing .
Fire Door/Door closers
Plumbing Fixture/3"Vent through roof[Modular]
Foundation insulation[if applicable]
Smoke/Carbon Monoxide Detectors/Interconnected
Final Electrical
ariance required
,l
/Data Plate okay
V Manufactured HUD seal okay /7 4 /- S✓
Warranty Seal after January 1,2006
Installers Warranty Seal
18"x 24"access or 22"x 30'attic access
Vapor retarder under home 6 mil poly or other
911 Street number
Okay to' -`- ,*�k„-r
Model# r,L I L ,
" I Itv Serial# I i1jC) 3 C'(- I
Manufacturer W7?Y ���1� \�- 3 l�
Date of Manufacturer 1 Z- —2EFT2)
L:\Pam Whiting\20101Building Codes Forms\Manufactured_Modular Final Inspection 03 04 10.doc
pLor PLP1N(
— - ________. , ___ _
--A-661-
..-?,Er_____D_- cr21.2L.P.161i
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC ,
St;Ob'dN ON THIS DOCUMENT.I HAVE PERSONALLY
ME .:,U ' D THE DISTANCE SET FORTH ON THIS DIAGRAM.
S -- .l"! ,,, DATE
NOTICE
ANCHORING OF MOBILE HOME
FRAME IS REQUIRED PER
MANUFACTURERS SPECIFICATIONS ra �il r:, ('‘(`)?\( B P / -3 - ,„
,,,„ „... t ; ,., „
19 TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance
w\*pX with our comments shall not be construed as
dicrating plans afications in
'I s, infuu compliancethe withano thes Buildeing Codesare of
New York State.
bO
4 TO \L
\ c
"') 3
\ >
Q°Re LA- At'V" mil'
,t -- 4 r
\"\ -
TOWN OF QUE 1B,. •Y
BUILDING & 0Dr ;I's ,-f, f�-' `��\
Reviewed By. /id �/ 1 U `
�c
Date: maw ��' I ,� � ��
_ _ MARCH RD At
001O11d1 ?W°
-i Q
,uo'J,
?Ca, I I I I 14 i, II -
I t W
oOkrik`7 - t�
f 41
a'ly� �
---
nL
VI 1
400
4 c1i - s_ 1 d 9