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2004-824 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 i.' Community Development - Building & Codes (518) 761=8256 CERTIFICATE OF OCCUPANCY Permit Number: P20040824 Date Issued: Thursday, April 14, 2005 This is to certify that work requested to be done as shown by Permit Number P20040824 has been completed. Tax Map Number: 523400-308-014-0001-052-000-0000 Location: :17 :BR-1W000 CYCLE Owner: ARC COMMUNITIES 14, LLC Applicant: FOREST MOBILE HOME PARK i This structure may be occupied as a: By Order of Town Board Mobile Home In Park TOWN OF QUEENSBURY Director of Building&Code En4t� 1' TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040824 Application Number: A20040824 Tax Map No: 523400-308-014-0001-052-000-0000 Permission is hereby granted to: FOREST MOBRY,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 2004-824 17 BRIWOOD CIRCLE 2004 MOBILE HOME (924 SQ FT) $30.44 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, October 29, 2005 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the own Que bj; gFtd October 29, 2004 SIGNED BY � 17 for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit— Mobile Home Town of Queensbwy, 742 Bay Road, Queensbury, NY 12804 (518) 761-8256 A building permit must be obtained before placement of mobile home on parcel..No inspections will be made until a valid building permit has been issued. Applicant In formation Office Use APBI Fbl@ L? Name: r File Permit No. Address: 8. Fee Paid NU 12& Reviewed Phone No. Property Owner Infor7— Propertytion LInformafion R Proposed Date of Placement: Name: AI Mb p�1 Location: Address: u l�r`t�V ► 8 r. �C�� W Rwd,Sttet,Avme ame of Mobile Home Park: Phone No. Tax Map-Number: _ ./ .._.._ / ..... . Mobile.Horne Informafign _.._--. Zoning.Ir formation - Appioximate Value of Homer$ _ f EC��Ci�E Zoning Classification: New Home: Oes No OC I 1 9 200 _ Size of Property: ft.by=t1JWN 01_ QUEENSB RY Replacement Home: es No BUILDING ANp CO J Existing buildings: Size of Mobile Home: ft. by (o6 ft. Setbacks: front yard P'© ft.; rear yard ft. Singlewide: _ Doublewide: Side yards�ft.and f Number of Rooms: (exclude baths) Number of Bedrooms: 3 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 o municipal Piers s Runners x Is Septic Permit Required? Yes or No Slab x Further information requested on the reverse side of this sheet F _ Name of Installer or Mobile Home Dealer. Address: n 02, JVJ16kLI W 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 ONLY S_ Date of Manufacture:: _. AFFIDAVIT- - Town of-- -- _ - .. ... •...• ::.--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_ q signawre: owner, er's agent,architect,contractor i Special Conditions of Permit By Form: 11/19/1999sh Code Enforcement Officer FINAL INSPECTION REPORT MOBILE O MOOULAR Town of Queensbury Building & Code Enforcement J� 742 Bay Road Queensbury, NY 12804 (518) 761-8256 �� L� ARRIVEZEPART``;� �� .��D INSP: DATE INSPECTION REQUEST RECEIVED: NAME: 0 LOCATION: ,r i~ I .l. 1 \ mil, f C J / j PERMIT,# MOBILE HOME MODULAR HOME FOOTINGS FOUNDATION BACKF L.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, pouches, 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 ....................... 4 — 16. final electrical ........................ 7 — 17. variance required ..................... _ 18. data plate okay ....................... — — 19. mobile HUD seal okay .............. _ Model # ,'� �— Seriial#\ � Manufacturer l�I`l�1�� Date of.Manufacturer`)C-11-Q OKAY TO IS&bE C/O YES NO Comments: r. T 0 a O a 3 VN ' F11. F jnP NOTICE ANCHORING OF MOBILE HOME TOWN OF OUEENSB0.Y GUIL IV C�-PARTMENT FRAME IS REQUIRED PER Based o;l odr limited euami{la#ion, MANUFACTURERS SPECIFICATIONS Corr lisnle tier&our comments shall not 2 c,.mstrued as irhdicatincg the plans a„d afe ill full comp&:C;,,,a;iiEl fi C''13i1 Jinn Cores y of RECENED OCT 1 9 Z004 lU r ,,. TUNN Of,-- Q'JEENSBURY �. EU� ILBI v_G AND CODE REVIEWED BY LATE CC r � RECE, °E "_ OCT 1 9 2004 ,OWN OF OIJEENSBU L F -n; E m AW CODE r, ws7fuie _ �ii[ErL�iiAi - .. ' • �Svnf>•auaL . ut�sa aim T•ili F4 h T•^t � �� GScEPrJIFL6�[C�. i� ICY gum i '•S --- . �^ Imo'.`— .-. - - - -� •p+�� - � F/l+alr W 76r* .V.4M 13 174 Fir" IJ Ld t j�( 57PPOCYPObT I !s'!�! W v' r •1 ff rs r'S f �,.17F H ZwAvi OL LL it'Ii3S` � 6 1 9!' I Tb'^1Q i�Y• M{I'! ��a S7 ,�.,.• ,K 5-Nr ,} i �. a' EUZ4 ETHTOr1'J 22 'aa ra• - •rei;r�,rx��la�€ - ij} - PR8 Gorpornlir a 6x+L! 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