2004-827 TOWN OF QUEENSBUIRX
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
1
CERTIFI CATE OF OCCUPANCY
Permit Number: P20040827 Date Issued: Monday, June 06, 2005
This is to certify that work requested to be done as shown by Permit Number P20040827
has been completed.
Tax Map Number: 523400-308-014-0001-052-000-0000
Location: 183 PITCHER Rd (58 B)tiwood C.' cte)
Owner: ARC COMMUNITIES 14, LLC
Applicant: FOREST MOBILE HOME PARK
This structure may be occupied as a:
Mobile Home In Park By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the !J
property owner of the responsibility for compliance with Site Plan, VV
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
.742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040827 Application Number: _ A20040827
Tax Map No: 523400-308-014-0001-052-000=0000
Permission is hereby granted to: FOREST MOBT1,R HOME 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 Construetion Value
Owner Address: ARC COMMUNITIES 14, LLC
900 Mobile Home In Park $18,000.00
PO BOX 790830 Total Value $18,000.00
SAN ANTONIO, TX 78279-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-827 58 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 th :ft of Qu ®r,sb��, � ida October 29, 2004 .
SIGNED BY �l_� ems✓ f�".� • 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 Information -
Office Use
Name: File Permit No�
Address: J�� �e Of Fee PaidON D
12- I Reviewed By: -
Phone No.
Property Owner Information Parcel Information
I Vj) � it,
Proposed Date of Placement: .l
Name: I-PI -
nn� /n�h� Property Location: , l r
Address: 600 I�I'1"1V 1 V/., au16 �� Ro4
I Name of Mobile Home Park:
-.- (1faPplieab&)
�p 1 ,f� � J
Phone No. C��t�l � _- :_.:....... . ...:.... `�_
Tax
1l�Iobile Home Irr}orittation ..__.._-_. Zoningliformation _
_.
� �Cp ���
ApPtoximate Value of Home:
V��;� , 1.
Zoning CIassification:8R--LA O C T 2 9 211,
New Home: Yes No
Size of Property: ft.by 'N 0►=QUEENS 3 J �,
Replacement Home: Yes No �J(GGIf�iG r",NG cC(�E
Existing buildings: ,�
Size of Mobile Home: ft. by $.
Setbacks: front yard ft.; rear yard 16 ft.
Singlewide: Doublewide: Side yards eft.and ft.
Number of Rooms: (exclud bathS) .6
' 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 or municipal
Piers x
Runners x Is Septic Permit Required? Yes or No
Slab x
Further information requested on the reverse side of this sheet
P
-'4
Name of Installer or Mobile Home Dealer. 6 MeS
Address: ,0, ,1jL-16 � 2DW
Phone No. 8 ®�
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
- Date of Maniifactiire:
AFFIDAVI.T.. .
-- - = --
Town of Queensbuxy
--
._._ -. .. ..—State ofNew=Yoik
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 BUELDING 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 �4m,4
oN�merkoyuer's agent, contractor
Special Conditions of Permit
By
Form: 1 1/1 911 999sh Code Enforcement Officer
FINAL INSPECTION REPORT
MOBILE / MOOULAR
Town of Queensbury
Building & Code Enforcement
742_Bay Road
Queensbury, 'NY 12804 /
(518) 761-8256
ARRIVE: DEPART o INS t�
DATE INSPECTION REQUEST RECEIVE
NAME: Eb Re!!5V pA R I�
LOCATION: C) BRI tQUOS CAK
DATE: PERMIT.#ZDDLI
MOBILE HOME MODULAR HOME
FOOTINGS , FOUNDATION _ BACKFILL_ FRAMING
N/A YES O
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
i,
OKAY TO ISSUE C/O YES NO
Comments:
1 �SLAM UJ 1�L
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-6256
ARRIVE: DEPART: , II SP:----,
DATE INSPECTION REQUEST RECEIVE
NAME: Q
LOCATION: CR_a
DATE: A., --7, 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. 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: ('J
�'
�'i�INAL INSPECTION REPORT
MOBILE / M000LAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256 /0
,
ARRIVE: DEPART: �L� NSP:
F
DATE INSPECTION REQUEST RECEIVED:
NAME: ('
LOCATION:
DATE: "'C `�� PERMPiff�a7
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION BACI4ILL FRAMING
N/A YES NO
1. foundation support, pier spacing r
per manuf. ........................ _
V
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. fumace/hot water operating ........ _
11. garage fire proofing ..................
12. door closers
13. plumbing fixture ...................... _
14, foundation insulation (if appl.)......
15. smoke detectors .. _
16. final electrical .� ..�.ipi. ... _
17. variance required ..................... _
18. data plate okay .......................
19. mobile HUD seal okay ..............
Mbdel # Serial#������c��
Manufacturer 1j:4vAFtA4_2)�Z -`z�-��
Date of Manufacturers _ Z -.
OKAY TO ISSUE C/O YES 1K, NO
Comments:
AL INSPECTION REPORT
MOBILE / MOOULAR
Town of Queensbury
Building &Code Enforcement
742 Bay Road
Queensbury, NY -12804
(518).761-8256
ARRIVE: DEPART:VLWXN9Z4�i-
W)DATE INSPECTION REQUEST RECEIVE
NAME:
LOCATION:
DATE: PERMIT#
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION BACKFILL FRAMING
N/A YES NO
1. foundation support, pier spacing /
per manuf. ........................ — 0 —
2. anchoring per manuf. ............ — Y _
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, potches, steps, railing ........
10. fiumce/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 ISSOE C/O. YES NO
Comments:
f
1
T
O
60
O�.
` y)
FILE
TOWN OF QUEENSBURY BUILDING DER RT�JENT
Based on oar limited examination,
compliance bib oui comments shall
not �e construed as indicating the
plans and sa' cat ons are in full
compliance wilco the Building Codes
v of t cvj yt@Io.
J.
7 RECENED
OCT 1 9 2004 ly
fUt,`id i H'%;-S,URY PC
NOTICE
ANCHORING OF MOBILE HOME
FRAME IS REQUIRED PER n
i. MANUFACTURERS SPECIFICATIONS ` ��6 W` ``�' n ,my
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