RC-000350-2015 TOWN OF QUEENSBURY
4k 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-000350-2015 Date Issued: Thursday, December 24, 2015
This is to certify that work requested to be done as shown by Permit Number RC-000350-2015
has been completed.
Tax Map Number: 308.12-2-39
Location: 13 CENTRAL AVE
Owner: Kaylynda Lopez
Applicant: Kaylynda Lopez
This structure may be occupied as a:Placement of new Mobile Home on property.
Size: 65 ft.by 14 ft.= 1,036 sq. ft. By Order of Town Board
The mobile home is a rental and not owner occupied. TOWN OF QUEEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the ` / )„ _I/ 4
property owner of the responsibility for compliance with Site Plan, «<���///(((���++���"`
4
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-000350-2015
Tax Map No: 308.12-2-39
Permission is hereby granted to: Kaylynda Lopez
For property located at: 13 CENTRAL AVE
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
Owner Name: Kaylynda Lopez Mobile Home $35,000.00
Owner Address: 23 Stevens RD Total Value $35,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Sam Wahnon
Plans&Specifications
Placement of new Mobile Home on property.
Size: 65 ft.by 14 ft.=1,036 sq.ft.
The mobile home is a rental and not owner occupied.
$124.32 PERMIT FEE PAID-THIS PERMIT EXPIRES:
(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 Queen ury; n /� Fr' a , 4,2015
SIGNED BY: (,��Vy!('/ �VJ for the Town of Queensbury.
Director of Building&Code Enforcement
MOBILE HOME APPLICATION Office Use Only
Received
DATE: _��- I�- 15 Tax Map ID U /a--7-.39
cry
TAX Map ID Permit No. R�600 350
r�-f � �ac� 3 y
(�� � -} n Permit Fee
PROPERTY LOCATION: I, 1 i1/lti-1.�fLl.y �V'e �.�F� tr' ACL U. I(?
NAME OF MOBILE HOME PARK:
PROPOSED DATE OF PLACEMENT:
NOV 17 2015 6 y
APPLICANT L Z OWNER
ADDRESS J�t'111
ADDRESS
¢ n
PHONE G O - / PHONE
NAME OF INSTALLER OR MOBILE HOME:DEALER
ADDRESS:
BOTH 000 350-2015
Kay Lopez
p 13 Central Avenue
PHONE 711313
T1`n7 b - a 1z ( Year 2010 placement of mobile home on parcel
(rental and not owner occupied)
CONTACT PERSON FOR BUILDING&CODES-COMPLIANCE PHONE: --
COMPLETE INFORMATION BE OW FOUND ON A"PLASCER"WHICH IS AFFIXED TO THE MOBILE HOME
Insignia serial number
Name of Manufacturer
Place Approval Number
Model or Component Designation a a.5 (New home only)
Date of Manufacture: 02.010
MOBILE HOME INFORMATION ZONING INFORMATION
Approximate Value of Home $ 315 DDO Zoning
New Home or Replacement Size of property ft b tt.
y_
Size of Mobile Home j-LL-ft,by fL Existing buildings
Singlewide orpoublewide Accessory buildings
Number of rooms(exclude b$th) Storage buildings
Number of Bedrooms Detached Garage
Number of Bathrooms
Attached Garage ^1 _'2 —S.
Gas Replace;Woodstove or Wood Fireplace Setbacks.
Front yard: fL
Rear yard:._ft.
0CLS Side yards ft.
Foundation Support Size Depth Water Supply Well:
Piers Municipal.
Runners _
Slab Septle Pemrit Required? _YEs�No
Town of Queensbury Building&Codes1
Mobile Home Application July 2014
Procedure for placing and occupying a mobile home or modular home:
1. Application is submitted and review: 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 Town website
5. Septic Inspection, if needed
6. Final electrical Inspection
7. Stairs & platform covering door width and door swing with handraiis 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 site 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; Deposit$100.00 (refunded when all items are complete)
DECLARATIOM. 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 Occupancy.
Print Name: f/1 A I LopP Date:
Ow e , Ag nt, Contractor
Signature: Date: /0/-/S
Special Conditions of Permit:
By: Code Enforcement Officer
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Town of Queensbury Building&Codes Mobile Home Application July 2014