2005-660 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 FILE
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20050660 Date Issued: Thursday, September 22, 2005
This is to certify that work requested to be done as shown by Permit Number P20050660
has been completed.
Tax Map Number: 523400-308-006-0001-061-000-0000
Location: �� PETRIE Ln
Owner: SAMUEL & VIOLA WAHNON
Applicant: DONALD & JANICE MINER
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 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: P20050660 Application Number: A20050660
Tax Map No: 523400-308-006-0001-061-000-0000
Permission is hereby granted to: DONALD & JANICF,MINER
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
39 SARATOGA ROAD Mobile Home In Park $60,000.00
Total Value $60,000.00
GANSEVOORT, NY 12831
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-660 DONALD & JANICE MINER
29 PETRIE LANE 1344 SQ FT NEW MOBILE HOME
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, September 07, 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 To of eens , September 07, ZOOS
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit— Mobile Home
Town of Queensbwy, 742 Bay Road, Queensbury, NY 12804 (518) 761-82.S6
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 In
Office Use
Name: te E File Permit e—
Address: /D �,r,�7',� ,� iFee Paid
Reviewed B
Phone No. 7 70 Oft 7 qI WO
Property Owner Information Parcel Information
Name: � (, � ����
Proposed Date of Placement:
Property Location: , 4i m,
Address: .. c)( � Road,suvet,Ave=
Name of Mobile Home Park:
r s licabte 2DU 1 7 .
Phone No.
Tax Map Number: JAL_/ _/
Mobile Home Information . Zoning Information _.-.
Approximate Value of Home: S P
_ Zoning Classification:
New Home: Yes No 13 /C, j
7 Size of Property: ft.by 1 ft.
Replacement Home: Yes No
Existing buildings:
Size of Mobile Home: Cz�ft. by ft.
Setbacks: front yard ft.; rear yard ft.
Singlewide: Doublewide: X Side yards 10 ft.and ft.
Number of Rooms: (exclude baths)
Number of Bedrooms: S Accessory Building(s): circle
Number of Bathrooms: R
Detached garage: 1 car-, 2 car, car
circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1 car; 2 car, car
Storage building: Yes No
Foundation Support: Other:
.a
TYPE IZE&DEE211.Piers Water Supply: well or muni
_ s
Runners x Is Septic Permit Required? Yes ore
Slab s
Further information requested on the reverse side of this sheet W
Name of Installer or Mobile Home Dealer.
Address:
Phone No.
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home_
1_ Insignia serial number.
2. Name of manufacturer.
3. Plan Approval Number:
4. Model or Component Designation:
(New Home OK19
5. Date of Manufacture:
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,owner's agent,architect, ntractor
Special Conditions of Permit
Form: 11/19/1999sh de rce t
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building &Code Enforcement
742 Bay Road ��
Queensbury, NY 12804
(518) 761-8256
1-
ARRIVE: DEPART• .(b INSP:
DATE INSPECTION REQUEST RECEIVED:
NAME:
LOCATION:
DATE: __ ,� ��S PERMIT# o
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 a 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. f imace/hot water operating ........ _
11. garage fire proofing ..................
12. door closers ........................... — —
13. plumbing future ......................
14. foundation insulation (if appl.)...... _ —
15. smoke detectors -
16. final electrical .. ....... . _
17. variance required .....................
18. data plate okay ....................... — —
19. mobile HUD seal okay .............. —
Model erial it
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES , NO
Comments:
FINAL INSPECTION REPORT
MOBILE / MOOULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART:2 SP: v
DATE INSPECTION/R,EQUEST RECEIVED:
NAME: 2 D ^V/77o
LOCATIONQ9
YMID % !� PERMIT N 1?dJ 5
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION BACKF LL 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 (a 4 feet .......
5. heating crossover (dblewide) off grd. /
6. dryer vented outside ......................
7., skirting ventilated ....................
8. hot water relief valve piping outside _
9. deck, potches, steps, railing ........ / —
10. furnace/hot water operating ...... —
11. garage fire proofing ..................
12. door closers ........................... — —
13. plumbing fixture ...................... -
14, foundation insulati (if appl.)...... ✓
15. smoke detectors G 'T �'�.• Of
—
16. final electrical ........................
17. variance required ..................... — —
18. data plate okay ....................... —_
19. mobile HUD seal okay ..............
Model #1 t �� Serial It
Manufacturer
Date of Manufacturer b
OKAY TO ISSUE C/O YES V1 NO
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Liberty Arlington Approx. 1166 Sq. Ft. 28 x 48
ST284851
Glens Falls Mobile & Modular Homes, Inc. O _� l/
1304 Route 9 ll
Gansevoort, NY 12831
(518) 798-2801
Fax 798-28031UC '
www.gfmhomes.coin
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MANUFACTURERS SPECIFI TIONS
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