2003-584 A
TOWN OF QUEENSBURY
742 Bay Road,Queensbuty,NY 12804-5902 (518).761-8201
Community Development-Building&Codes (518)761.8256
CERTIFICATE
CIF OCCUPANCY
Permit Number: P20030584, Date Issued: Tuesday, September 30,2003
This is to ceriify that work requested to be done as shown by Permit Number P20030584
has been completed
Tax Map Number: 523400.308.014=0001.052.000.0000
Location: 49 Wwood Citete
Owner. ARC4BFND,LL,C.
Applicant: FOREST MOBILE HOME PARK.
This structure may be occupied as a:
By Otder of Town Boatd
Mobile Home In Park TOWN OF QUEENSBURY
Diteetot of Building&Code Edoteement
TOWN OF QUEENSBURY
742 Bay Road;.Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
{
Permit Number: P20030584 Application Number: A20030584
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: FOREST MOBILE 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-die Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: ARC4BFND, L.L.C.
PROPERTY TAX DEPARTMENT TotlMobile Home In Park $22,00.0.00
PO BOX 13244 Total Value s22;000.00
EL PASO,TX 19913-3244 _
Contractor or Builder's Name/Address Electrical Inspection Agency
i
Plans&Specifications ..
A2003-584 FOREST MOBILE HOME PARK 49`BRIWOOD CIRCLE
1216SQ FT MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS
a
$47.96 PERMIT FEE PAID-THIS PERMIT'EXPIRES: Friday,August 06,2004
(If a Ionger 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 To n of eensb d sday,August 06,2003
SIGNED BY for the Town of Queensbury.
Director of Building&Code nforcement
V Application for Permit-- Mobile Home
Town of Queenshwy, 742 Ray Road Oueensbury, NY 12804 (�"�1�-.8)_W�-8
f E VED
A building permit must be obtained before placement of mobile home on parcel. No ecti will be made
until a valid building permit has been issued. �' 003
Applicant Information Quizr_JAJODUKY .
OffcelMse G AND CODE
Name: (��tCSg �t�1�L L C ��b�0�, �02xy__ _ 4�P File Permit No
x ;
Address: 1� 1-p1' dpar 9_.
Fee Paid q
2 ernSbur �.q IaP Reviewed By:
Phone No.
U- 99Lo �
9 � � �
Property Owner Information ParlelInfionnation ..
otze T Proposed Date of Placement:
Name: A .1ff P-,C QFnl1>�-.L.0 . JXJOa pvmy- m4c,
Property Location: LO . e)(►L000d. CI rde,
-Address: tvoo &QAPJr ST. 5ui-rE 160 Road,Steet Avenue
l�i~n3�EKZ C(a Sozo3 Z52-8 Name of Mobile Home Park: 1rt V_iE,6T t" AP_K. M 14C:-
(if applicable) "
Phone No. 800 r_� 5415
Tax Map Number: Wi
Mobile,Dome Information Zoning Information
Approximate Value of Home: S 9A
Zoning Classification:"
New Home: Yes No r`1j
1 Size of Property: ft.by $.
Replacement Home: Yes No DePT►A
Existing buildings: N b tU�"
Size of Mobile Home: �_ft. by �ft. , � -
Setbacks: front yard I ft, rear ya:44" ft.
Singlewide: � Doublewide:_ Side yards fM) ft.and--&W�ft.
Number of Rooms: (exclude baths) _
Number of Bedrooms: 2) Accessory Building(s): circle
Number of Bathrooms:'
Detached,garage: 1 car; 2 car, car
circle: Gas Fireplace 1 Woodstove/Wood Fireplace Attached garage: 1 car, 2 car, car
Storage building: Yes No
Foundation Support: Other:
TXPE SIZE&DEPTH Water Supply.. well or unicipal
e- X
Runners x Is Septic Pernut'Required? Yes or No
Slab � `
Further information requested on the reverse side of this sheet W
�y.
Name of Installer or Mobile Home Dealer. �o I I aA -Uonrle6
Address: r)o a 2) l w t.J64QLI l ac)c Q
Phone No. (51 S) L -a L} — 6509
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
1. Insignia serial number. O R) 5 A A
2. Name of manufacturer. f n a Y 1e- e— Sch =
3. Plan Approval Number:
4. Model or Component Designation: ('0 —
(New Home ONLI') ,r1
5. Date of Manufacture:
AFFIDAVIT -
Town of Queensbury 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 cif the BUILDING CODE,the
ZONING ORDINANCE, and all other laws pertaining to the proposed work
shall be complied whh,whether specified, or.not,.and that such work is
authorized by the.owner.
Signature: _
owner,ovine ' 4nt,archit ntractor
Special Conditions of Pennit
By:
Form: 11i19/1994s Code Enforcement Officer
IF=I L- I ff%M IM 1=E=
Tc3wn oDf C;lu4e nsk:)LLiry
Ouilcling 8L CC<:)O*a -E=-nfc:ProE3mf3nt
742 E3Ay FRpacl
C:WoOnsk3ury, NY - 12804
(518) 761-8256
DATE INSPECTION REQUEST RECEDED: ��
DATE: #
N/A 'StE
NCb
I- fboullclati4con support, Piew spac-' g .yt
perTruAlIllf.. .................... .....
2. avLr--hc.>rirxg per rrindailF. ...... .... .
3- vvatt--r lixi4a- sftxxt off --------------- ----
4- sf--Npvt--r lixic-- support (gP 4 feet .. .. .. .
5_ dryer vented outside ---- ---------------
---- ----------------
18- ftc)t vv.-.xtt--r relief valve pipirl,9 outside
9- clo'g-R. Ixrches, steps, railing --------- -
vvntc--r cPpt--jr-,xtijag -------- 00,
es proofing ------ - - ------ - - ---
12- 4dc>c>r closers ---- --------- ---------- ----
13. pluxxi'birxg fixture:-- --- -- ----- -- -- -------
14. ftniamd.-tticma insulation (if LtPPI.).. . . ..
JLS- SXIi-Okv-- detectors ................ .........
16. final electrical _________________ _______
1"7. variance ve�qxjirc�d ---------- -----------
IS- data plate: 6ka3i ----------- -------------
Vq- rrlcA5,ile- HLTD sc,al okay ........ . .......
MuNdk--1 # Serial #
Manufacturer -
Bate of Manufacturer
OKAY -rC)o I[SSTJIF- C--/C) YES ND
F=I",OZSL&- =RM5=CMFW-lr
- Town of Clu4a nsUury
Ruilclino 8L CDcx:J*at F-Rnf<3rocam4ant
7'42 E3aLy Flc>a�d
C)uaanst3ury, NY - 12804
(518) 761-8256
DATE INSPECTION REQUEST RECEIVED: d
A-1
ol
40Y
13A0=1<JFlll .1
N/A YES C7►
I fcamaclaticoxi support, pjic�r spw--ma
perrvLa-lauf- ---------------- -- - -----
ajac--hK>ril-ls pf--r- rna.11mar. .. ... ----
3- vvatf--r lixie- shut c3fF -- - ------ ---- --- '000
4- se-vvt--r lirxt-- s"ppc:pr-t 4 feet
r 5- dryer -vc-pxvented outside -------------------
-
7- skix-tirlg -vc--riti-Intfa-a -- ------------ ------
8- Hcpt water relief v.-Ll-vt-- piping outside
9- cic-cR, porches, Steps, railing .. .... ..
10. fUnaac:g--/ftcA vvfxtt--r c>ptar"tirig ----- -- -
11- garage fire- proofing - ----------- - - ----
1:2. cic>c:)r closers - ------ - - ------- -- - - -------
13- plXvml:>ijao fixture. . . ...... . ......... ....
14. foundation insulation (if apPl.)---- --
Is- smac3ke, dAAIO�ratoprs ----- ---- - --------- -- - -
16. fix al ...... ........ ....
17. variance required ---------------------
18. data plate. 6"y --- -- ------ - -- ------- - -
19- KrlcA.>ilc-- IAT-Jll> seal o1caY ------ - - ------
model #
manufacturer �z�
oe:
C>F,-.,Ok,Y -rc> ISSTJIF CIC� YES NO
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