RC-0099-2018 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-0099-2018 Date Issued: Wednesday, May 9, 2018
This is to certify that work requested to be done as shown by Permit Number RC-0099-2018
has been completed.
Tax Map Number: 308.6-1-61
Location: 28 Petrie LN
Owner: Deborah McNally
Applicant: Deborah McNally
This structure may be occupied as a: New Manufactured Home, including
attached porch By Order of Town Board
28 ft. by 62 ft. = 1,736 sq. ft. TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the `
property owner of the responsibility for compliance with Site Plan, r 04ko ®d
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-0099-2018
Tax Map No: 308.6-1-61
Permission is hereby granted to: SAMUEL WAHNON
For property located at: 28 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
Owner Name: SAMUEL WAHNON Mobile Home $91,000.00
Owner Address: 1304 Route 9 Total Value $91,000.00
Gansevoort,NY 12831
Contractor or Builder's Name/Address Electrical Inspection Agency
SAMUEL WAHNON
1304 Route 9
Gansevoort,NY 12831
Plans& Specifications
New Manufactured Home, including attached porch
28 ft.by 62 ft.= 1,736 sq. ft.
$ 347.20 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, March 21, 2019
(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 ueen Lp ed a March 21, 2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
MANUFACTURED HOME Permit#:
d PERMIT APPLICATION Permit Fee:$ -2o
Town of Queensbwy
742 Bay Road,Queensbury,NY 12804 Rec Fee:$
P:518-761-8256 www.gueensbury.net
Invoice#: 0165
r--,
Project Location: � 2— ' Tax Map ID#:
Name of Park: Lq�C ram' . ' ( Proposed Date f P a t���..../
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CONTACT INFORMATION:
MAR 15 2018
TOWN OF QUEENSSURY
• Applicant: BUILDING&CODES
Name(s): y ! r
Mailing Address, C/S/Z: LDr �
Cell Phone: 1 ` ) ''Zq �y�i '2 Land Line: ems)
Email:
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Primary Owner(s):
Name(s):
Mailing Address, C/S/Z:
Cell Phone: _) Land Line:)
Email:
• Contractors :
Business Name: t�
Contact Name(s): rti
Mailing Address, C/S/Z:
Cell Phone: ( 0s Land Line: '7c 53'-2-9'- I
Email: Z)04io I &y.—
Contact Person for Building & Code Compliance: - �G�V --
Cell Phone: ��) �� ���-� Land Line:
Email:
Town of 4ueensbury Building&Code Enforcement Manufactured Home Application Revised May 2017
MANUFACTURED HOME INFORMATION:
(INFORMATION FOUND ON THE PLATE OR STICKER LOCATED IN THE HOME):
Insignia serial#: �L L` " �� 7 iL'�I :7�i L
f
Name of Manufacturer: &-7L'r- y :'%1 �--
Place approval #:
Model or component designation (New Home Only):
Date of manufacture:
ADDITIONAL INFORMATION:
1. Approximate Value of Home:$ Iq t ell �C
2. Is the home NEW 'L\ or a REPLACEMENT ?
3. Single-wide or Double-wide ; Size. '-3 ft.X L2- ft.
4. Foundation support(choose one): Size Depth
Piers:
a
5. Is the home being placed on a private lot? No Yes (if yes,you must provide stamped engineered
drawings of the permanent foundation plan)
6. Total#of rooms(exclude bathrooms): #of bedrooms: ;#of bathrooms: 2--
7. Additional heat source? No Yes Choose one, if yes: gas fp woodstove® wood fq
8. Are there any other/existing buildi gs=an�he property? No'- Yes_; Explain: _ _
9. What Is the water source? �C PRIVATE WELL
19. Is the parcel on SEWER or PRIVATE SEP system?
11. Do you need a septic permit application? No Yes
DECLARATION:
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 NYS Building Code,the Zoning Ordinance and all other laws pertaining to the
proposed work shall be completed with
I have read and agree to the above:
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PRINT NAME: J ''( ►��t
.—. / (n �
SIGNATURE: �-`� I e, � 10°LL`-G '� DATE:
1
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017