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2004-318 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 C E IRTIFICA`I'E OF OCCUPANCY Permit Number: P20040318 Date Issued: Thursday, June 17, 2004 This is to certify that work requested to be done as shown by Permit Number P20040318 has been completed. Tax Map Number: 523400-308-014-0001-052-000-0000 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 Ayorcebknt TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20040318 Application Number: A20040318 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. Tie 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 2004-318 43 BRIWOOD CIRCLE 924 SQ FT MOBILE HOME $60.00 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 Town of Queensb Ftl ,May 21, 2004 SIGNED BY '. for the Town of Queensbury. Director of Building& ode Enforcement Application for Permit— Mobile Home Town of Queensbwy, 742 Bay Road, Queensbury, IVY 12804 (518) 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 Veen issued. Applicant Information Office Use Name: File Permit No. LLLJ Address: I �� 11��� Fee Paid ' •' l�� Reviewed ByQ�� f - !E :_.___.._""'-.—__�..._...�_..... ...,tea �.. J....... a ..!.�." Phone No. (vi AW 1 4 20 04 Property Owner Information Parcel Information OWNOFQ EENSBURY % !D CODE �o(2CST Proposed Date of Placement: Name: Ag.Off lsp ID -pgwy- &iNc- Property Location: 1'_'� B r rakD Address: 1,0 CUO &RA"l- ST. 5u rrE q 00 Road,srtet,Avenue �ir,.11�Ei2 : CO $0203_S(YX8 Name of Mobile Home Park: !roV-CST—VAR.k M NCr (if applicable) Phone No. SGb 94(5 '-')415 Tax Map Number: 5A Mobile Home Information Zoning Information Approximate Value of Home: S Zoning Classification: New Home: es No Size of Property: ft.by ft. Replacement Home: Yes No Existing buildings: Size of Mobile Home: ft. by ft. Setbacks: ftont yard fh, rear yard ft. Singlewide: Doublewide: Side yards ft.and . ft. Number of Rooms: (ex clud 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: I car; 2 car, car Storage building: Yes No Foundation Support: Other: TYPE SIZE&DEPTH Water Supply. well or unicipal Piers x SlabRunners x Ara Is Septic Permit Required? Yes orCO Further information requested on the reverse side of this sheet � Name of Installer or Mobile Home Dealer: 1�1a(Lu Yl Address: © d,Z . car)o nu - ® � Phone No. 8 —" 606 Complete information below found on a"plate" or"sticker"which is affixed to the mobile home. 1. Insignia serial number 2. Name of manufacturer. r I-ee+, 3. Plan Approval Number: 4. Model or Component Designation: (New Home ONLY) 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: : owne ,owner's agent,architb6t,contractor Special Conditions of Permit By. Form: 11/19/1999sh Code Enforcement Officer FILIAL INSPECTION REPORT MOBILE / MODULAR Town of Queensbury Building & Code Enforcement. �+ 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: DEPART: 2` DATE INSPECTION REQUEST RECEIV NAME: LOCATION: ' (zA�6jA �r)cc DATE: PERMIT#c o00q -3f MOBILE HOME V MODULAR HOME FOOTINGS FOUNDATION BACIFILL 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 Q4feet _ — 5. heating crossover (db ) off grd. 6. dryer vented outside ...................... 7.• skirting ventilated .................... _- 8. hot water relief valve piping outside — V// — 9. deck, porches, steps, railing ........ 10. fimmce/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 lA�O)y Date of Manufacturer OKAY TO ISSUE C/O YES NO Comments: r 1 RECEIVE® iiiA ' 14 2004 TOWN OF QUEENSI3URY ,D BUILDING AND GOUE NOTICE Oo ANCHORING-OF MOBILE HOME FRAME IS REQUIRED PER MANUFACTURERS SPECIFICATIONS 1 44 a c TOWN OF QUEENSBURY B, ILDING DEPARTMENT �( M . Based on oUr limited examination, compplianoe with our comments shall 1+n not be construed as indicating the plans and specifications are in full compliance with the Building Codes of New York State. BUILDING & C3D IPT. 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