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CD CD a (� o `° � a o � W N � � O n �-' 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-000736-2016 Tax Map No: 308.12-2-7 Permission is hereby granted to: DKC Holding For property located at: 43 Minnesota 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 Tvce of Construction Owner Name: DKC Holding Mobile Home $6,000.00 Owner Address: 6 Holden AVE Total Value $6,000.00 ,NY 12804 Contractor or Builder's Name I Address Electrical Inspection Agency Combs Trucking 96 VAN DUSEN RD Queensbury,NY 12804 Plans&Specifications Single-Wide Mobile Home 540 s.f. 13.5 R.x 40 ft. $64.80 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,October 27,2017 (If a longer period is required,an application for an extensi n must be made to the code Enforcement Officer of the Town of Queensb ore the ext tin ate.) Dated at the Town of ueensb (r Th ober 27,2016 SIGNED BY: "" for the Town of Queensbury. Director of Building&Code Enforcement MOBILE HOME APPLICATION Office Use Only �+,.( Received DATE: [ 1 7 Tax Map ID TAX MAP ID Permit No. �¢ Permit Fee JR(a Rte PROPERTY LOCATION: NAME OF MOBILE HOME PARK: PROPOSED DATE OF PLACEMENT; Op APPLICANT 77 C-i, ` �. 1(� OWNER ADDRESS iL-tJ Aloe-- AD DRESS. _..3.40 t2 - R -7 tVlr \-SNOV PHONE ! PHONE ` t 9 3 -]X 7 7 NAME OF INSTALLER OR MOBILE HOME DEALER C O l �� ADDRESS: r ate PHONE ,3 ;>-77 CONTACT PERSON FOR BUILD/NG&CODES-COMPLIANCE: PHONE: COMPLETE INFORMATION BELOW FOUND ON A"PLATE"OR'STICKER"WHICH ISIX::r=D:TO THE MOBILE HOME Insignia serial number �S ��ctq� Name of ManUfacturer Place Approval Number Model or Componeni Designation (New home only) Date of Manufacture: g 9 qo MOBILE HOME INFORMATION ZONING INFORMATION Approximate Value of Home $ Zoning R New Home or Replacement Size of property tt.by ft Size of Mobile.Home i3•s ft.by. 4a fL Existing buildings Singlewide or Doublewide ef, (� Accessory buildings Number of rooms(exclude bath) Storage buildings Number of Bedrooms Detached Garage —1 -2 ,Jg Number of Bathrooms ' Atfacbed Garage ^j —'2 Gas Fireplace;Woodstove'or Wood Fireplace Setbacks Front yard: ft. Rear yard;,, tt. Side yard: ft. Foundation Support Stze Depth Water Supply Well: Piers l Municipal: —K— Runners _ Slab Septic Permit Required? XYes _,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 handrails on both sides of platform and stairs are required for all exterior doors. S. 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) DECLARATION. I swear that to the best of my knowledge and belief the statements contained in this application, together with the plans and specification uiar i(ted, are a true and complete statement of all proposed work to be done on the described premises an at all pr vis' s of the Building Code, the Zoning Ordinance, and all other laws pertaining to the proposed work all be corn a whether specified or not, and that such work is authorized by the owner. Installer Warrant ill b o ' d e of Certificate of Occupancy. Print Name: Date: 4v er ent, Contractor Signature: Date: Special Conditions of Permit: By: Code Enforcement Officer 2 Town of Queensbury Building&Codes Mobile Home Application July 2014 SEPTIC DISPOSAL PERMIT Office Use Only DATE Oo Lzio l l to Received �f tax-lhdp ID TAx MAP ID 305. %,-I- Permit No. 6 201 b Ti3OPermit Fee nn '�',, - LOCATIONOFINSTALLA770N qZZ t J Frn.rB'�a7� ` i� Approvals: APPLICANT Cl/ ^ �/ —��ccs [i✓�L_ PHONEIE-MAIL 77 _ ADDRESS INSTALLERIBUILDER. //'' r� /` t ((��✓� PHONE/E-MAIL L ADDRESS: p yXg�Jav OWNER PHONE/E-MAIL Address Ca 41&A&.p , - CONTACT PERSON FOR BUILDING&CODES COMPLIANCE I PHONE—: : (0 RESIDENCE INFORMA77oN Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow 1980 or older Garbage grinder installed _Y N 1981-1991 Spa or Hot Tub installed _Y N 1992-Present O \O PARCEL INFORMATION Topography _Flat rolling _Steep slope _%slope Sal Nature Sand _Loam _Clay _Other Groundwater At what depth? Bedrock/Impervious Material At what depth? Domestic Water Supply Municipal —Well(Uwe][,water supply from any septic system absorption is_fL) Percolation Test Rate: per minute per inch(test to be completed by licensed engineering/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION Tank Size _\QcoQ gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub) System Type Absorption field with#2 stone Total length 100 ft.;Each trench -2- x So Seepage Pit with#3 stone How many: :size Alternative System Bed or other type? Holding Tank System Total required capacity? Tank size #of tanks Notes: 1)Alarm system&associated electrical work must be inspected by aTown approved electrical inspection agency;2)We will no longer allow systems to be covered until such time as an As-Built plan is received&approved. The installed system must match the septic system layout on file-no exceptions. DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or failure to make a material fact or circumstance know by or on behalf of an applicant,shall be void. I have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Print Name: Date: Signature: Date: 6 Town of Queensbury Building&Codes Principal Structure Application July 2014