2004-793 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: P20040793 Date Issued: Monday, November 22, 2004
This is to certify that work requested to be done as shown by Permit Number " P20040793
has been completed.
Tax Map Number:, 523400-308-014-0001-052-000-0000
Location: 183 PITCHER Rd
Owner: ARC COMMUNITIES 14, LLC.
Applicant: LEE LINETTE
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: P20040793 Application Number. A20040793
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: I,F,F,T.INFTTF.
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: ARC COMMUNITIES 14, LLC
900 Mobile Home In Park $18,000.00
Total Value $18,000.00
PO BOX 790830
SAN ANTONIO, TX 78279-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2004-793 Linette Lee 20 Briwood Circle
New 924 sq. ft. Singlewide Mobil Home Forest Park
$30.44 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday, October 25,2005
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town 4uee jrT o � y� etober 25,2004
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit— Mobile Home
Town of Queensbwy, 742 Bay Road, Queensbury, NY 12804 (518) 761-8256
A building permit must be obtained before placement of-mobile home on parcel. No inspections will be made
until a valid building permit has been issued.
Applicant In
Office Use
File Permit No.
Name: L/114k Lee,
Address: RLU6 QQ0,58 -964b Fee Paid 4
ocr
Reviewed By: . TQ '� 8 2004
Phone No.
E
Property Owner Information Parcel Information
J Proposed Bate of Placement: -'
Name: l9w.V P f NJ) �CAL 9 k
y� �� I'i,3
Address: 600 ]�!� C7 l. � �� �Q� Property Location: Road,Stet,A� �l�' �,
ff P (2L, 8D`�—�Z Name of Mobile Home Park:
-- -- if Pp
Phond No.
Tax.Map Number: / !
Mobile.Home lr formation.-- Zonin -
g
Approximate Value of Home:$
Zoning Classification: LA
New Home: es No
Size of Property: ft.by I&
Replacement Home: Yes No 6?c el- 13
Existing buildings:
Size of Mobile Home: ft. by 64—ft.
Setbacks: front yard ft.; rear yard ft.
Singlewide: Doublewide: Side yards ft.and ft.
i Number of Rooms: (exclude baths) 15
Number of Bedrooms: Accessory Building(s): circle
Number of Bathrooms:
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 SIZE&DEPTH Water Supply: well orE�D
Piers s
Runners x Is Septic Permit Required? Yes or No
Slab s
Further information requested on the reverse side of this sheet 201*
t
Name of Installer or Mobile Home Dealer. P&UV
mes
Address: `tT
Phone No'. T�� ,�--
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
1. Insignia serial number. __... . .._- _.. .
2. Name of manufacturerQQ(^j
3. Plan Approval Number: ��cOtJTi
4. Model or Component Designation:
(New Home ONL19
5. Date of Manufacture:
AFFIDAVIT- -
Town of --
--
Queensbur},: —State afNew work --
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: Al P
owner er's agent,architect,contractor
Special Conditions of Permit
Form: 1 111 91199 9sh 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: INSP:
DATE INSPECTION REQUEST RECEI E A.
NAME:
LOCATION:
DATE: c�-�-�C� PERMIT#
M0131LE HOME MODULAR HOME
FOOTINGS FOUNDATION BACKF LL FRAMING
N/A YES NO
1. foundation support, pier spacing
per manuf. ........................ — �L —
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. f imace/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 hYES NO
Comments:
c —wt 7 3
ii77 r7
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a Ep
REVIEWED BY 1
DPxTE
f
" A
S
TOWN OF QUI-RNS02PURY`�IJI RNG DE ',RTMENT
based on o lirii)t examination, ; .
cam fiance wit i our comments shall
— nat �e canstrued as indicating the
plans anti speciFica`aorns are in full
corrmlia-+ce with the Building Codes
-t-; of New York State. ;
FILE J
COPY
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