2004-316 TOWNOF UEENSBURY
Q It
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community-Development - Building & Codes (518) 761-8256'
CERTIFICATE OF OCCUPANCY.,
Permit Number: P20040316 Date Issued: Monday, June 28, 2004
This is to certify that work requested to be done as shown by Permit Number P200403.16 .
has been completed.
Tax Map Number: 523400-3'08-014-0001-052-000-0000
Location: 183 PITCHER Rd
Owner: ARC COMMUNITIES 14, LLC
Applicant: FOREST PARK/ARC
This structure may be occupied as a:
By Order of Town Board
Mobile Home In Park TOWN OF QUEENSBURY
.Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040316 Application Number: A20040316
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: FOREST PARK/ARC;
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 in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: ARC4BFND, L.L.C.
PROPERTY TAX DEPARTMENT Mobile Home In Park $18 000
Total Value $18,000.00
PO BOX 81290
CHICAGO, IL 60681-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-316 41 BRIWOOD CIRCLE
840 SQ FT MOBILE HOME
$29.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, May 21, 2005
(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 T Queen ry• ri ay 21, 2004
SIGNED BY for the Town of Queensbur
y.
Director of Building&Code Enforcement
QName of Installer or Mobile Home Dealer: `
Address: F(D
Phone No. 5 8 -' 68 1 j
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
1. Insignia serial number.
2. Name of manufacturer. L EeT"e).D
3. Plan Approval Number:
4. Model or Component Designation:
(New Home ONLY)
5. Date of Manufacture: O200 Ll
AFFIDAVIT
Town of Queensbuiy 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.
.4
Signature:
o r,owner's agent,architect,contractor
Special Conditions of Permit
By:
Form: 1111911999sh Code Enforcement Officer
Application for Permit— Mobile Home
Torn of Queensbwy, 742 Bay Road Queensbury, NY 12804 (d 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 In
Office Use
Name: 15A 8-9 File Permit No. Z (10
_ �
LID
Address: <� �l�L I Roa D Fee Paid
Reviewed By: n
Phone No.
TOWN OF QUEENSBURY
Property Owner Information ParcellnformationBUILDING AND CODE
2oaCST Proposed Date of Placement: Z 61�
Name: 'PT;-►e V_ na W_
Property Location: &'Q V/00 D �' k&u
Address: LcOC) &QA' 4r ST- 5u l"E 'U) Road,Shet,Avenue
I)Er lUEl2 Name of Mobile Home Park: lrog_E6T—PAW M
(if applicable)
Phone No. 800 c;4-5 _174 15 Tax Map Number:
Mobile Home Information Zoning Information
Appro.}dmate Value of Home: S
Zoning Classification:
New Home: Yes No
Size of Property: ft.by ft.
Replacement Home: Yes No
Existing buildings:
Size of Mobile Home: ft. by ft. T
Setbacks: front yard fi_; rear yard ft.
Singlewide: j_ Doublewide: Side yards ft.and ft.
Number of Rooms: (exclude`baths)
Number of Bedrooms: 2 r Accessory Building(s): circle
Number of Bathrooms: 23
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:
TYPE S=&D Water Supply. well or unicipaI
Piers Vl � s
Runners V X. Is Septic Permit Required? Yes or No
Slab s /V
Further information requested on the reverse side of this sheet �
FINAL INSPECTION REPORT
_ MOBILE / MADULAR
Town of Queensbury
Building &Code Enforcement
742 Bay Road
Queensbury,'NY 12804
(518) 761-8256
ARRIVE: DEPART: f((�INSP:
\ `�
mod'---
DATE INSPECTION REQUEST RECEIVED:
NAME: LO
LOCATIOrN::�
DATE: _ash�D 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 ......................
T. skirting ventilated .................... —_
8. hot water relief valve piping outside _ _ —
9. deck, porches, steps, railing ........ —
10. fiimace/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 ..............
Model # . Serial#
Manufacturer
Date of Manufacturer
OKAY TO ISSUE CIO, ' —YES, NO
Comments:
C_ o
oe<
FINAL INSPECTION REPORT P3o
fiil1owLE / MOOULAFR ,!
Town of Queensbury
Building & Code Enforcement
742.Bay Road .
Queensbury, NY 12804
(518) 761-8256 /
ARRIVE: DEPART,T5 INSP:
I"-
DATE INSPECTION REQUEST RECEIVED:
NAME:
LOCATION: (
DATE: '� PERMIT.#
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION BACK FILL FRAMING
N/A , YES NO
1. foundation support, pier spacing /
per manuf. — —V-- —
2. anchoring per manuf. ............... _ 1�/ _
3. water line shut off
4. sewer line support Q 4 feet ....... — —
5. heating crossover (dblewide) off grd. _r/ _ —
6. dryer vented outside
7. skirting ventilated .................... _
8. hot water relief valve piping outside
9. deck, porches, steps, railing ........ — _✓/ —
10. furnace/hot water operating ........ _ _V _
11. garage fire proofing .................. _
12. door closers ........................... ~_ _
13. plumbing fixture ...................... —
14. foundation insulation (if appl.)...... _✓ ' _
15. smoke detectors �r
16. final electrical -
17. variance required ........ .....
18. data plate okay ................
19. mobile HUD seal okay
Model # 5otic C`S Serial # Z<0 V
Manufacturer ,' %
Date of Manufacturer
OKAY TO ISSUE CIO YES NO
pCxPaS� �oT �3 a -c�l�-rA,v t`�
o�mmments:
/'v4'rf L e D c Tec-70 ��, ���
FINAL IN'l;l'iPECTION REPORT
MOBILE f IMOOLILAR
Town.of Queensbury
Building & Code Enforcement
742.Bay Road
Queensbury, NY -12804
(518) 761-825
"
ARRIVE: DEPART: INSP: ,O IV
"
DATE INSPECTION REQUEST RECEIVED: d
NAME: ?4��/Jy
LOCATION: d.&ej'--
DA;0%;k�yPH 64116V PERMIT#
M0131LE OME 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. ..............
Model # Serial #
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments: 1 d/c.a�jt,/6 Ldcl&"
2 .
'G
RECEIVED .
p:r
14 2004
TOWN OF nl
LA ILUI sr AND CODE
do
= � p,NCHURING R Q 1RE�PAR p�1S
�RA�tE 1S SPECIFICA�1
/� dL. MANUEA�.IURERS
I
�"! �� � fir. RY
Q1.j >a� .�r
TOWN OF QUEENSBURY BUILDING DEPARTME ` ILDING & 0T�
Based on odr limited examination, V
compliance with our comments shall
not be construed as indicating the REVIEWED BY
plans and specifications are in full 6
compliance with the Building Codes ®ATE
of New York State.
' 4
OCT-30-2002 11 :04 AM ForestParkMHC 5187450808 P. 01
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