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2005-329 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20050329 Date Issued: Wednesday, June 08, 2005 This is to certify that work requested to be done as shown by Permit Number P20050329 has been completed. Tax Map Number: 523400-308-014-0001-052-000-0000 Location: 183 PITCHER Rd ( 14 TimbeA Lane) Owner: ARC COMMUNITIES 14, LLC Applicant: FOREST MOBILE HOME PARK 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 )J W 4 -- property owner of the responsibility for compliance with Site Plan, 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 12804-5902 (518) 761-8201 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20050329 Application Number: A20050329 Tax Map No: 523400-308-014-0001-052-000-0000 Permission is hereby granted to: FOREST MOBH.F. 140W.PARK For property located at: 183 PITCHER 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 ui compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Tyne of Construction Value Owner Address: ARC COMMUNITIES 14, LLC 900 Mobile Home In Park $30,000.00 Total Value $30,000.00 PO BOX 790830 SAN ANTONIO, TX 78279-0000 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications a2005-329 14 TIMBER LANE 1216 sq ft MOBILE HOME $47.96 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday, May 23, 2006 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date. Dated at the Town of Queen ury; o day, May 23, 2005 SIGNED BY for the Town of Queensbury. irector of Buildin Co nforcement Application for Permit— Mobile Home Torn of Queensbwy, 742 Bay Road, Queensbuny, IVY 12804 ( 18) 761-8256 A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a valid building permit has been issued. Applicant Information Office Use DE C CG' V E Name: ako, Vim''File File Permit No.�J �C..�J '7� � MAX Address: 'f'/ Fee Paid ` TOWN UILDING AND CODE Reviewed By: 'f 7. Phone No. NO Property Owner Information Parcel Information *2Csz Proposed Date of Placement: 59110, Name: AP-Qff19PtID 0 Trpfry- 14W Property Location: Address: to UO &eAl Ti" 6T. 5u rrE 4W Road,Sues,Avenue �En1yEi2 _ -Cp 8©1 0� 5-2-� Name of Mobile Home Park: iroy.i ST�IN�ZK M I4C-- (if applicable) Phone No. Boo �;46 -54 15 Tax Map Number: '30$•� /._j � / 5�: Mobile Home Information Zoning Information Approximate Value of Home: S_aC Zoning Classification: New Home: Yes No Property:Size of Pr e ft.by Replacement Home: Yes No Existing buildings: Size of Mobile Home: it. by ft. Setbacks: front yard ft.; rear yard ga-ft. Singlewide: Doublewide: Side yards ln ft.and L5 ft. Number of Rooms: (ex clu a baths) Number of Bedrooms: Accessory Building(s): circle Number of Bathrooms: Detached garage: I car, 2 car, car circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1 car, 2 car, car Storage building: Yes No Foundation Support: Other: TYPE S=&DEPTH Water Supply. well or unicipal Piers x Runners x Is Septic Permit Required? Yes or No Slab x Furtlier information requested on the reverse side of this sheet Name of Installer or Mobile Home Dealer: Raun=2d Address- ou Phone No. �l8 i�- " C05 Complete information below found on a"plate"or"sticker"which is affixed to the mobile home. t , 1. Insignia serial';t ber 2. Name of manufacturer. 3. Plan Approval Number: ' 4. Model or Component Designation: (New Home ONLY) 5. Date'of Manufacture: V 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: owner, is agent,architect,contractor Special Conditions of Permit By: Form: 11119/1999sh Code Enforcement Officer FINAL INSPECTION REPORT MOBILE / MODULAR Town of Queensbury Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: DEPART: NSP: �l DATE INSPECTION REQUEST RECEIVED: NAME: LOCATION: DATE: "C � PERMIT# " MOBILE HOME MODULAR HOME FOOTINGS _ FOUNDATION _ BACKFILL_ FRAMING_ N/A YES NO 1. foundation support, pier spacing per manuf. ................. _ 2. anchoring per manuf. ............... _ _ 3. water line shut,off ................... . _ _ 4. sewer line support ®4 feet ....... 5. heating crossover (dblewide) off grd. / _ 6. dryer vented outside ...................... _ 7.. skirting ventilated .................... — 8. hot water relief valve piping outside 9. deck, porches, steps, railing ........ 10. furnace/hot water operating ........ _ 11. garage fire proofing .................. 12. door closers ........................... 13. plumbing fixture ...................... 14, foundation insulation (if appl.)...... 15. smoke detectors .............. 16. final electrical 17. variance required ..................... 18. data plate okay ....................... _ 19. mobile HUD seal okay .............. _ 1r Model # Serial# H Manufacturer \(kF.� � Date of Manufacturer OKAY TO ISSUE C/O YES NO Comments: co oz CO CD <3 IG)C) >C M zM z 00M < 4 Cn Oa) c:D 4 C-71 M MODEL 1680-2 M CDco I BED ROOM,2 BATH co N06,f I NAL SIZE: 16';e.80' ACTUAL SIZE: 15'-2"x76!-0' Tr If% TOTAL AREA: 1153 30, FT. co MANUFACTWW� ` ac MASTER DININGBDRM BEDROOM ' -!FX LIVING 9'-9,x 1 13'-3'x 14'-2" ROOM 15'-8'x 14'-2' BDRM#2 CD W-5'x 14'-2" � ------ KITCHEN -w TOWN OF QUEENSBURY BUILDING DEI ARTti ENT Based on oUr limited examination, co BUILDING ot LO compliance with our comments shall 0 C\j not be construed as indicating the FILh UOPY plans and specifications are in full R E V I E W E D B3!Y T-, compliance with the Building Codes DATE &--- of Ww York State. Lr) o Dik.PIA SEAL FAC-DIFICATI �NS AMDEL! C"i - -�= 1680-2 1 e x 00,3 hdnt. 1, L-1 01 I TFIL TITAN HOMES � _ T LITERATURE PLAN PR()PRLE7ARYA.','D CONFIDUFFAL DR-WRT SY.STAFF 134TF-,E4-22-Ck3 THESE DRAVANGS-V4O SPECIMAPON3AREOF06nPi UE1ARYX4DCC?4M SCA ra'=1,-o :X:1::7�7M�12� SANG&2k— LF: REGFIVED _ TOWN Uk gUEENSBURY 1ILDINU AND CODE e 4 j 4 r , €EFS L.--�- _„..-f. _ ... ._...__.�.. V \ Lf (rq g `