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2004-823 TOWN -OF QUEENSBURY 742 Bay Road-,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE O.F. O.CCUPANCY Permit Number: P20040823 Date Issued: Thursday, April 28, 2005 This is to certify that work requested to be done as shown by Permit Number P20040823 has been completed. Tax Map Number: 523.400-308-014-0001-052-000-0000 Location: 14 -BRIW60D CIRCLE Owner: ARC COMMUNITIES 14, LLC Applicant: FOREST MOBILE HOME PARK 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: P20040823 Application Number: A20040823 Tax Map No: 523400-308-014-0001-052-000-0000 Permission is hereby granted to: FOREST MOBTf E HOMF,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 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 2004-823 14 BRIWOOD CIRCLE 2004 MOBILE HOME (924 SQ FT) $30.44 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, October 29, 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 own o uee u y, October 29, 2004 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit— Mobile Home Town of Queens&wy, 742 Bay Road Queensbug, 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 Name: File Permit No. 0 Address: R Fee Paid J Reviewed By: r Phone No. j Property Owner Information Parcel Information // pp TOP .Proposed Date of Placement: 0.. . Name: Property Location:`/ Address: Qk�}AffV -re qo Rom Sheet,Aveme I � _ Name of Mobile Home Park: � �Tf � i a_ 7:cable(" ..pp ' ) Phone No. Tax Map:Number: Mobile.Home Information.,_ -_._ .---... :Zoning.Ixcformation Appiroximate Value of Home-'S Zoning Classification:dy� New Home: Yes No Size of Property: ft.by LZ ft. Replacement Home: Yes No Existing buildings: Size of Mobile Home: ft. by 6 ft. Setbacks: front yard 26 fL; rear yard ft. Singlewide: Doublewide: Side yards 1ft.and ft. Number of Rooms: (exclude baths) 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 orCmumcipal Piers s Runners x Slab s Is Septic Permit Required? Yes or No \ Further information requested on the reverse side of this sheet Q_U 46 ms I 1A Name of Installer or Mobile Home Dealer: 'do, - Address: b-4-6 n MIA 12,020 . Phone No. f U 42A—.1'l5 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 ONLY) 5. Date of Manufacture: - AFFID-AVI.T.. . ° 'Town of - —State ofNow Ydik Qneen.-1, __._.. . . . . 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: own er's agent,9diftect,contractor Special Conditions of Permit By Form: 1111911999sh Code Enforcement Officer FINAL INSPECTION REPORT MOBILE Z 1 OOULAR Town of Queensbury Building & Code Enforcement 742 Bay Road Queensbury, IVY 12804 (518).761-8256 ARRIVE: DEPART: �I NSP- DATE INSPECTION REQUEST RECEIV D- NAME: LOCATION: DATE: _�-� -Lgj 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 ...................... — I — 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 ES NO Comments: FINAL INSPECTION REPORT MOBILE /.MODULAR. Town of Queensbury Building &Code Enforcement 742 Bay Road Queensbury, NY 12804 . (518) 761-8256 l ARRIVE: DEPART:gAtINSP- t DATE INSPECTION REQUEST RECEIVED: NAME: Pa LOCATION: DATE: PERMIT 3 MORILE.;HOME MODULAR HOME FOOTINGS FOUNDATION BACKFH.L 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. f imace/hot water operating ........ _ 11. garage fire proofing................... 12. door closers ........................... — _- 13. plumbing fixture ...................... _ 15. smoke 14, foundation insulation (if appl.)...... detectors .. ............ — 16. final electrical ...................... — — 17. variance required ..................... 18. data plate okay ....................... 19. mobile-HUD seal okay .............. _ Model 0/—Z-fz�'•�A Serial 1. . 42 �3 Manufacturer'h_L—LC -j Date of Manufacturer �L�cz� OKAY TO ISSUE C/O YES NO Comments: R,&l r L--b 5 BY THIS CERTIFICATE OF COMPLIANCE THE � C 5 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 S 5 BUREAU OF ELECTRICITY 5 5 40 FULTON STREET — NEW YORK, NY 10038 CJ 5 CERTIFIES THAT 5 5 5 5 Upon the application of upon premises owned by 5 5 5 5 SHAWN ARRUDA AMERICAN RESIDENTIAL COMMUNITY 5 183 PITCHER RD.QUEENSBURY, NY 12804 183 PITCHER RD. 5 C5 QUEENSBURY, TN, NY 12804 5 S at Located 5 5 _ 14 BRIWOOD CIRCLE QUEENSBURY, TN, NY 12804 5 Application Number: 3043072 Certificate Number: 3043072 5 S 5 5 Section: Block: Lot: Building Permit: BDC: A239 5 5 5 Described as a 5 Residential occupancy, wherein the premises electrical system consisting of Cj 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 5 First Floor,Outside, 5 5 5 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard 5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other C5 5 authority having jurisdiction, and found to be in compliance therewith on the 16th Day of August,2007. 5 5 Name QTY Rate Rating Circuit Type 5 5 Panels 5 5 1 100 20 5 5 Service 5 5 1 Phase 3 W Service Rating 100 Amperes 5 5 Service Disconnect: 1 100 cb 5 5 Meters:l- - 5 An as built inspection,of the delineated electrical installation,determined that an obvious hazard is not present and the installation is believed to 5 5 be in comformance with the applicable reference standard for the estimated period of construction of the premises wiring system. 5 5 5 5 5 5 -: sea/ S 1 of 1 5 5 S 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 5 5 a nnn�n�n��r�rs�.n�.rr��n�s��n��n� 3 r ON 0 f� 7� �P FILECOPY NOTICE ANCHORING OF MOBILE HOME RE � FRAME IS REQUIRED PER g Z004 MANUFACTURERS SPECIFICATIONS OCT TOWN Oi €3U�ti , CODE Via � TOWN OF RTMENT � Eased cit otlr.limil�ld examination, .J compii:ance tiAm,h our comments shall rot Le cons-trued as indicating the X plans and specifications are in full -1, compliance with the GuMing Codes L of NeUv'bit State. cc T J,V BUILDING REVIEWED BY � nQ DATE y tug. 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