RC-0396-2021 Office Use OnlEWIAP
MANUFACTURED HOME
Permit#:
PERMIT APPLICATION Permit Fee:$
Town ofQueensbury
742 Bay Road,Queensbury,NY 12804 � p
P:518-761-8256 www.gueensbury.net Rec Fee: $
Invoice#: 'gyp
Project Location:
31 Woodland Path Flood Zone? Y b Reviewed By:1_lLL�
Tax Map ID #: 0S • r l "'52— D IE U
Name of Park (if applicable): Forest Park MHC, LLC
PROJECT INFORMATION: TOWN OF QUEENSBURY
BUILDING& CODES
1. Proposed Date of Placement: 08-01-2021
2. Approximate Value of Home:$ 50,000.00
3. Is the home NEW x or a REPLACEMENT ?
4. Single-wide or Double-wide Size:- 16 ft.X 76 ft.= 1216 total square feet
5. Foundation support(choose one): Size Depth
x Piers: 2411 48
11
Slab:
6. Is the home being placed on a private lot? No x Yes"
(**if yes,you must provide stamped engineered drawings of the permanent foundation plan)
7. Total#of rooms(exclude bathrooms): 5 ;#of bedrooms: 3 ;#of bathrooms: 2
8. Additional heat source? No x Yes Choose one, if yes: gas fp_ woodstove_ wood fp
9. Are there any other/existing buildings on the property? No x Yes ; Explain:
10. What is the water source? PUBLIC x PRIVATE WELL
11. What type of wastewater system is on the parcel? SEWER PRIVATE SEPTIC x
12. Do you need a septic permit application? No x Yes
MANUFACTURED HOME INFORMATION:
(INFORMATION FOUND ON THE PLATE OR STICKER LOCATED IN THE HOME):
Insignia serial #: 112000HDC407242A
Name of Manufacturer: Campion -Topeka
Place approval #:
Model or component designation (New Home Only): D01680 RHPFK7616
Date of manufacture:
Manufactured Home Application Revised January 2021
� 4
REQUIREMENTS FOR SUBMITTAL:
1. Completed Manufactured Home permit application
THREE (3) COPIES OF THE FOLLOWING:
2. Structural drawings, which include:
a. Floor plan
b. Foundation plan (see 2015 IRC Appendix E Section AE502: foundation systems)
c. If the home is being placed on a private parcel (not in a manufactured home park or designated
zone),you MUST provide stamped engineered drawings of the permanent foundation plan.
3. Plot plan, using a survey map if possible, which includes:
a. Drawn to scale (i.e. 1 inch =30 feet)
b. Indicate proposed location, with setbacks
c. Include all structures on the property
d. Include location of water supply (well or water lines)
e. Include location &configuration of septic system or sewer line
ADDITIONAL SUBMITTAL INFORMATION:
1. Installer Warranty seal must be provided prior to issuing Certificate of Occupancy.
2. Any changes to the approved plans prior to or during construction will require the submittal of
amended plans, additional reviews and re-approval.
3. If, for any reason, the building permit application is withdrawn, 30%of the fee is retained by the
Town of Queensbury. After 1 year from the initial application date, 100% of the fee is retained.
4. Workers' Comp insurance information for all contractors involved—REQUIRED, EVEN FOR SOLE
PROPRIETORS
DECLARATION:
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 NYS 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.
I have read and agree to the above:
PRINT NAME:
SIGNATURE: DATE:
Manufactured Home Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Forest Park MHC, LLC
Mailing Address, C/S/Z: 183 Pitcher Road Queensbury, NY 12804
Cell Phone: _( Land Line: ( 518 ) 745-7776
Email: forestpark@rhp.com
Primary Owner(s):
Name(s): Forest Park MHC, LLC
Mailing Address, C/S/Z: 183 Pitcher Road Queensbury, NY 12804
Cell Phone: ( Land Line: ( 518 ) 745-7776
Email: forestpark@rhp.com
❑ Check if all work will be performed by the property owner onl
• Contractor(s): (List all additional contractors on the back of this form)
Contact Name(s): Dan Hunt/ Hunt Home Services
Contractor Trade: Site Prep/ Home Set Up
Mailing Address, C/S/Z: 36 Brickoven Rd. Queensbury, NY 12804
Cell Phone: ( 518 ) 361-2931 Land Line:
Email: dirtywhiteboy970@yahoo.com
"Workers' Comp documentation must be submitted with this application"
Contact Person for Compliance in regards to this project: Jack Evans - Community Manager
Cell Phone: ( 513 ) 160 Land Line: ( 518 ) 745-7776
Email: forestpark@rhp.com
Manufactured Home Application Revised January 2021
NEWYORK Department
STATE OF..
.OPP,.ORTUNITY21" of Health
ANDREW M. CUOMO HOWARD A. ZUCKER, M.D.,J.D. LISA J. PINO, M.A.,J.D.
Governor Commissioner Executive Deputy Commissioner
June 11, 2021 FTOWNOF
1/1
Forest Park MHC, LLC
Attn: Joel Brown 21
31200 Northwestern Hwy SBURY
Farmington Hills, MI 48334 DES
RE: Forest Park Mobile Home Court
Facility code: 56-6822
(T)Queensbury, Warren County
Install mobile homes on Lots 9, 15, 16,49, 58, 69, & 78 Briwood Circle; Lot 17
Gregwood Circle; Lot 12 Timber Lane; and Lot 31 Woodland Path
Dear Joel Brown:
We have this day, approved the plans for the above-referenced project. Application for this
project was initially received on May 24,.2021, with additional,information received June 9,
2021, and duly submitted by Jack Evans on form DOH-154 (Notice of Intent)that proposed to:
• Replace an existing 3-bedroom, 14-foot x 66-foot mobile home on Lot 9 Briwood Circle
with a 3-bedroom, 16-foot x 76-foot new mobile home:
• Replace an existing 3-bedroom, 14-foot x 70-foot mobile home on Lot 15 Briwood Circle
with a 3-bedroom, 16-foot x 76-foot new mobile home.
• Replace an existing 3-bedroom, 14-foot x 70-foot mobile home on Lot 16 Briwood Circle
with a 3-bedroom, 16-foot x 76-foot new mobile home.
• Replace an existing 3-bedroom, 16-foot x 76-foot mobile home on Lot 49 Briwood Circle
with a 3-bedroom, 16-foot x 76-foot new mobile home.
• Replace an existing 3-bedroom, 16-foot x 66-foot mobile home on Lot 58 Briwood Circle
with a 3-bedroom, 16-foot x 76-foot new mobile home.
• Replace an existing 3-bedroom, 14-foot x 66-foot mobile home on Lot 69 Briwood Circle
with a 3-bedroom, 16-foot x 76-foot new mobile home.
• Replace an existing 3-bedroom, 14-foot x 66-foot mobile_home on Lot 78 Briwood Circle
with a 3-bedroom, 16-foot x 76-foot new mobile home.
•. Replace an existing 3-bedr6om, 14-foot x 70-f6ot:mobile home on Lot 17 Gregwood
Circle with a 3-bedroom, 16-foot x 76-foot new mobile home.
• Replace an existing 3=bedroom, 20-foot x 66-foot mobile home on Lot 12 Timber Lane
with a 3-bedroom, 16-foot x 76-foot new mobile home.
Glens Falls District Office,77 Mohican Street,Glens Falls,NY 12801,518-793-3893 gfdo@health.ny.gov
• Replace an existing 3-bedroom,'24-foot x 66-foot mobile home on LOSM110=3MV101
with a 3-bedroom, 16-foot x 76-f6ot new mobile home.
The Department has no objection to the proposed action and the work may proceed conditioned
on the following:
1. The new home may not have a garbage grinder, whirlpool bath/spa, or any other high
usage fixtures.
2. If the onsite wastewater treatment systems fail, the systems must be brought into
compliance with current regulations.
3. Approval must be granted by other agencies or�municipalities having jurisdiction.
4. Homes and accessory buildings or structures must be installed such that a minimum
separation distance of 10 feet exists between any home, building or structure on any
other site or parcel of land. If improper separation distances are observed on the above
lots in future inspections, enforcement action will be taken.
Additionally, please note that this approval expires 1 year from the approval date.
Sincerely,
John C. Schroeder
Senior Sanitarian
NYSDOH - Glens Falls District Office
77 Mohican St.
Glens Falls, NY 12801
(518)793-3893
Cc: Rebecca C. Bussert,Acting District Director, Glens Falls District Office
Kevin Kenyon, P.E., Glens Falls District Office
Town of Queensbury Building Department
File
PAFacility Folders\Forest Park Mobile Home Court\Correspondence\Forest Park Lots 9,15,16,49,58,69,&78 Briwood;Lot 17
Gregwood;Lot 12 Timber;Lot 31 Woodland NO[Approval 06-11-21.136cx
Glens Falls District Office,77 Mohican Street,Glens Falls,NY 12801,518-793-38931 gfdo@health.ny.gov
16t x 76' Box • PROPERTIES americans home
20,24"x48" INGROUND PIERS
_x------7)71, -- x — —1 x I -- 1 x 1 -- Ix ---� — x -- ° x ---�x -- x I
99.5" 99.5" 99.5" 99.5" 99.5" 99.5" 99.5" 99.5" 99.5" 99.5"
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x I—s'oc_I x(_s�oc_ x I _s oc_f x a'oc_177,77_ x i s'oc I z'oc
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-- -- --- --- #---- -- ---1-----
2' 10' 18' 26' 34' 42' So' S8' 66' 74'
Community: Forest Park(NY) Site Number. W031
Equals pier location-Note all measurments are to the centers of the piers. Approved: /Ze�CCtL W"al
Information prepared based upon soil bearing capacity for the Site and calculations performed in accordance with the DAPIA approved factory set up manual.
*** PLEASE NOTE - HOME IS ORDERED WITH PIER SAVERS AND DOOR PIERS ARE NOT REQUIRED PER MANUFACTURER.
THIS INFORMATION IS AVAILABLE ON THE HOME ORDER AS WELL AS THE DATA PLATE FOR CONFIRMATION AT TIME
OF FINAL INSPECTION.
✓Safety First- All work to be conducted abiding by all industry safety rules & regulations
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PROPERTIES I america"s home'
Manufactured Home
Drainage
Inground Pier Footing
manufactured home
Gravel bed under home
must have a crown to insure
'/z" per foot drop skirting no water remains under home
for drainage 10 to gravel I
into yard
mesa
All grade material must be
compacted to a minimum concrete pier �' ": _. LEGEND
of 90%compaction. footing =Existing grade
Width and depth
of foundation pier = 6" minimum Gravel"
determined by
manufacturers = Rough graded
set up manual
to achieve 1/z" per
foot drainage
Vendor Initials: Illustration 2 * Suitable material can replace gravel
in non-frost susceptible areas.
March 2019 For illustration purposes only- Must follow instruction of manufacturers installation manual, HUD CFR 24-3280, 3285, 3286 and local codes.
✓Safety First- All work to be conducted abiding by all industry safety rules & regulations
L
• PROP E RT I ES I america's home`'
Manufactured Home
Drainage
"Do" and "Do Not"
DO crown and grade site to DO NOT grade site or set the home so
slope away from the home. that water collects beneath the home.
n
minimum
F� F-1 F-1
minimum slope
'/z" per foot A-," I► ii i&
' minimum
El
minimum slope
'/z" per foot �►
Home sites shall be prepared so that there will be no depressions
in which surface water shall accumulate beneath the home.The
area of the site covered by the manufactured home shall be
graded,sloped or mechanically designed so as to provide drainage
from beneath the home.
Vendor Initials: Illustration 5
March 2019 For illustration purposes only-Must follow instruction of manufacturers installation manual, HUD CFR 24-3280, 3285, 3286 and local codes.
✓Safety First- All work to be conducted abiding by all industry safety rules & regulations
Ce
PROPERTIES I america"s homed
Manufactured Home Set
Typical Footing and Pier Design
Shims, when required, are to be used in pairs, must be
4" x 6" x 1" in size, installed in opposite directions and be
fitted and driven tight between main I-beam frame and
shims or caps below. Shims can't occupy more than 1"
Main I-beam of vertical height.
Hardwood plates, shims, or other listed materials not
exceeding 2" in thickness.
'/2" x 8" x 16" steel caps, 2" x 8"x16" hardwood caps, or
minimum '/2" x 8"x16" concrete caps, or other listed
materials. See§3285.304(b)(2) for cap requirements.
Note - steel caps must be protected by a minimum of a
=, 10 mil coating of an exterior paint or an equivalent
corrosion resistant protection.
Single open or closed concrete blocks 8" x 8" x 16"
Less than conforming to ASTM C-90 installed with 16" dimension
36" *_ '' y perpendicular to the main I-bean frame. Open cells are
in height s" placed vertically on footing. Mortar is not required
unless specified in the manufacturers installation
instructions or required by a registered professional
- engineer or registered architect.
Typical footing. Solid concrete or other product
approved for the purpose. Footing is placed on firm
undisturbed soil or on controlled fill, free of grass and
organic matter.
See manufacturers In freezing climates, the footing must extend below the
installation manual for frost line or be otherwise protected from the effects of
instructions for piers over 36" in height.
frost heave as permitted here-in.
Vendor Initials: Illustration 16
March 2019 For illustration purposes only- Must follow instruction of manufacturers installation manual, HUD CFR 24-3280, 3285, 3286 and local codes.
vol"Safety First- All work to be conducted abiding by all industry safety rules & regulations
ce
PROPERTIES I america"s home'
Tie-Down Anchoring
RHP-approved anchoring systems:
- Tie Down Engineering K2 System
- Oliver Technologies, Inc. oo Ground Level
- Minute Man Stabilizer Plate
- Central Piers, Inc. Diagnal/Frame
Consult manufacturer's installation manual for requirements on frame
and vertical sidewall anchoring, spaing and quantity of anchor points, Ground Anchor Longitudinal !:
and method and configuration of strapping.
F
When installing anchors, ensure there are no obstruction underneath
the home or potential for damage to underground utilities. Ground anchors and stabilizer plates must be installed at the
Note: Public and private locating of proper angles, frame straps must be wrapped at least one
underground utilities must be completed revolution over top of the main I-beam, as well as multiple
before installing ground anchors. times around the anchor bolt, and must also be properly
tensioned according to the installation instructions.
Note: Straps should be protected at sharp at sharp
- corners and when wrapped around the I-beam.
l s 1
Vendor Initials: Illustration 35 Ground Anchor and Strap
April 2020 For illustration purposes only-Must follow instruction of manufacturers installation manual, HUD CFR 24-3280, 3285, 3286 and local codes.
] n 4
Aft p PROPERTIES, HOMESITE SURVEY ' - Left Corner
ameticas borne" '
Community Name: Ed(n�- Pos Site#: W O
City Set Backs: Front Yard: U Rear Yard (end to end): ( + Side Yard: 6, _F_�- I
Recommended Home Size:- ' 1 G X 76 Are Overhead Power Lines Present? Yes N-No
Considerations in Determining Home Size: Se.�cLc"
i
Source of Home Heating (check box): 0 Natural Gas 'Propane F—].Heating Oil Electricity
Please provide a Drawing in the center space above that indicates the elements listed below with measurements:
• Existing pad runners/ribbons or Piers • Existing driveway• Existing approach (walkway to home)
• Locate sewer,water,electrical • Indicate the location of natural gas hookup,propane tank or heating oil tank,if applicable.
Home
Home 1
i
y ��-.
Total Length of Site
(Distance from home to curb) Distance between homes
-�
Total feet between
,� home and curb
m
I
11 Addition, r
fr. Steps
Width or Deck
of Porch or NA 3
-h
-7f� o i
Depth of Porch i
Carport
Yes or No
x
size: i
Distance from
Show Ircationof home to curb
overhe
STREET Make measurement
to back of curb
Maximum Bdilding Envelope Size: Width: Length: 76
Name of person filling out this form: 6. Date: Z1 176 Form Revised
October 2019
DEC E- HVJE -
JUN 2 3 2021 11
TOWN OF T-13-RY
5D