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2013-455 TOWN OF QUEENSBURY FOTO 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20130455 Date Issued: Wednesday, April 22, 2015 This is to certify that work requested to be done as shown by Permit Number P20130455 has been completed. Location: PETRIE Ln Tax Map Number: 523400-308-006-0001-061-000-0000 Owner: SAMUEL & VIOLA WAHNON Applicant: SAMUEL & VIOLA WAHNON This structure may be occupied as a: Mobile Home In Park By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the property ��,( owner of the responsibility for compliance with Site Plan, Variance, or VVV ,4,52t other issues and conditions as a result of approvals by the Planning Board Director of Building&Code Enforcement or Zoning Board of Appeals. 00h4 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20130455 Application Number: A20130455 Tax Map No: 523400-308-006-0001-061-000-0000 Permission is hereby granted to: SAMUEL&VIOLA WAHNON For property located at: 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 Value Owner Address: SAMUEL& VIOLA WAHNON Mobile Home In Park $40,000.00 39 SARATOGA ROAD Total Value GANSEVOORT,NY 12831 $40,000.00 Contractor or Builder's Name/Address Electrical Inspection Agency GLENS FALLS MODULAR 1304 STATE ROUTE 9 GANSEVOORT NY 12831-0000 Plans&Specifications 2013-455 Mobile Home 28'x 37' Marlette NTA 1593240/1593241 3/15/2013 Serial #111115AB $124.32 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,October 18,2014 (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 Qu nsbu A Fr'i .y/!et t ter 18,2013 SIGNED BY - for the Town of Queensbury. Director of Building&Code Enforcement • Tow of Queensbury Building & Codes Office Use Only MOBILE HOME APPLICATION Received: Tax Map ID: 0 . „ - - L2 Permit No.: 3 — A permit must be obtained before placement of mobile home on parce[. No .,;; inspections will be made until a valid building permit has been issued. Permit Fee: $ 1 Applicant ( (A ��-tiQ,x--_- Property Owner t-x.:` A 4_14.„0---11t---- Address —Address 1L-1- 1(? r -t> Address (fie 29 Phone [q .23- 1 Phone qq -2--T Contact Person for Building&Code Compliance: 1A '-6`,—_- Day Phone: ---iq r _co Name of Installer or 1 Proposed Date of Placement f'r`54 l7 Mobile Home Dealer � CCc��g'.iu 1tiC . � �" � � ./�. �. Name of Mobile Home Park �Zlr A,���C/'wc.0 � P Address I't 4 f�l' i .7 uti ' Y Property Location j_D 7- / Phone r7q -z-.7b r77—z—. if Tax Map ID 1 7—I - (o ^ 9 Complete information below found on a"Plate" or"Sticker"which is affixed to the mobile home: • Insignia serial number: ' C` V ) / I (? IS 6 • Name of Manufacturer: • Place Approval Number: • Model or Component Designation: N Tr9- /Sq/32f-(a /5'" 324 (New home only) • Date of Manufacture: 3 — 15:- / 2) Mobile Home Information Zoning Information Approximate Value of Home $ (1-0 0C/C Zoning New Home or Replacement 1Q--Q.,,0 Size of property ' ft.x /40 ft. Size of Mobile Home 2.3( ft.by Ti ft. Existing Building(s) N"--a/L-5 Singlewide or Doublewide L Accessory Bldgs. Number of Rooms(exclude bath) Storage Building(s) Number of Bedrooms 7— Detached Garage _1 car _2 car _3 car Number of Bathrooms 2i Attached Garage _1 car _ 2 car _3 car Gas Fireplace Setbacks Front Yard: feet Woodstove Rear Yard: feet Wood Fireplace >- Side Yard: 2,5 feet Foundation Support Size Depth Water Supply Well Piers) urncipa )C Runners Septic Permit Required? Slab /'Lt L 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) ✓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/ /1Occcupancy. Print Name: l/t 1.( !L of'i Signature: ( t � A Owner,Owner's Agent,Contr tor Date: T -( / 3 Special Conditions of Permit: By: Code Enforcement Officer Town of Queensbury Building&Codes Mobile Home Permit 518-761-8256 N\0 t 1'O Queensbury Building & Code Enforcement — Manufactured / Modular Final Inspection Office No. (518)761-8256 Arrive: am/pm De rt am/pm Date Inspection request received: 141 15 Inspector's Initials: NAME: WGOr�l�arl PERMIT#: -ZrD LOCATION: \ Pekirl Q _ _.) DATE: i ` 20 j2015 Manufactured Home Modular Home Footings_ Foundation_ Backfill_ Framing Comments: Yes o N/A Foundation support,pier spacing, Per manufacturer Anchoring per manufacturer 2'from ends1// j' Z-- C( (g Water line shut off Sewer line support @ 4 feet Heating Crossover[doublewide}off grd. Dryer vented outside Y Skirting ventilated 1 sq.ft.per 1,500 sq.ft. ,� Hot water relief valve piping outside V/ Deck,porches, steps,railing Fumace/hot water operating V� Garage Fire proofing Fire Door/Door closersAl// Plumbing Fixture/3"Vent through roof[Modular] ,- � Foundation insulation[f applicable] VVr/ Smoke/Carbon Monoxide Detectors/Interconnected / Final Electrical V. / Variance required V f Data Plate okay ,/ Manufactured HUD seal okay V Warranty Seal after January 1,2006 / / Installers Warranty Seal Il 18"x 24"access or 22"x 30"attic access Vi Vapor retarder under home 6 mil poly or other 911 Street number Okay to issue C/C or CIO[Temp_/Perm.] 6/(..../ .. ---z.. ., 6"-. Y� FR/C-0-3-C--)-5 Model# Serial# Manufacturer 54,. — Date of Manufacturer L-1Pam Whiting120101Building Codes Forms\Manufactured_Modular Final inspection_03 04 10.doc INSTALL-NO. 21010 STATE OF NEW YORK DEPARTMENT OF STATE ONE COMMERCE PLAZA N14. 99 WASHINGTON AVENUE - ALBANY,NY 12231 INSTALLER'S WARRANTY SEAL THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE ti NEW MANUFACTURED(HUD CODE) ❑ RELOCATED MANUFACTURED(HUD CODE) )1,c J l A. Manufacturer's name: 01 nN One"�C 1 t`.)1,c 4-t,c:,.k S `' 1.t !f {- LP B. HUD label number:NTU TA I{S—�3 2 (v I\1 I A 15 e) 3 2`- ! Serial number:Le W !! I 1 S P rt C. Retailer's name lI T-� P,rl ; S {l��A2, 4 E' �? .< <� �'�- ✓ti C�r )-o n 1�5 b, L_ D. Retailer's address: I C' -( `-( CY -.j c'c r 4 N "( 1 Z a E. Retailer's certification#:–RE I DI?37 . ! Telephone#: �/8- 7 5s - 42 8 0 F. Installer's name: rY1 V P. t t'UCr 1 V (..2 A G. Installer's address: t o Trl AVL°. . QL)ee n S J►r N ) 12 i3�t H. Installer's certification#: I ( N T 0 0 3 73 Telephone#: .S'8 -232 - 3(007 I. Date installed: M c�c • 2 3, 27, 15 Municipality issuing building permit: Qi-)e e ) (City(Town Village) J. Customer name and physical address (911)where home is installed: TT) oci k 17 Pe-f- ( e+re LC,nQtFr,5 6,)/1) 1Z Cy ,New York. 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: = ��tet' ( • LOC(1o 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 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 Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: Q r 11I) ? 41.E p ,�y PERMIT NO.: f _ 3 7 g LOCATION: r ji / e 4-r j INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand/ Loam / Clay Type of Water: Municipal / Well Water g 3 Waterline separation distance ft. r Well separation distance ft. r Other wells: ft. Well Casing Length 50' + / - Y N N/A [150'to well required if NO] Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number _ Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: _Y_ N End Cap Y_ N Inlet/Outlet Pipes&Baffles 1Y— N Manholes 12"or less below grade _Y N [provide extension collar if Yes] _Y_N Location/ Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built _Y— N ETU Maintenance Contract Y_ N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: 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 4 ` TOWN OF QUEENSBURY FO11742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 N Community Development-Building& Codes (518) 761-8256 Inspections per Permit Permit # P20120378 Inspection Date Inspection Type Approved/Denied Comments Permit Type Person Responsible 08/07/2012 Miscellaneous Septic Alteration Residential STAFF Misc 2012-378 Lots 17& 19 permit app rec'd&entered 08/08/2012 Miscellaneous Septic Alteration Residential STAFF Misc 2012-378 permit issued 08/09/2012 Septic Septic Alteration Residential JOHN O'BRIEN Partial 2012-378 Municipal Water- DOH Mike Shaw on site ELJEN indraw Bldg to tank NOT installed PVC perf to Eljen uutlett-partial 10/21/2013 Miscellaneous Septic Alteration Residential STAFF Misc 2012-378 status slip issued