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2003-648 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804.5902 (518)761.8201 Community Development.Building&Codes (518)761.8256 nrDT IT, UtAlIFICATEur OC. CUPAN... CY Pemut Number, P20030648 Date Issued: Monday, October 04,2004 This is to certitify that work requested to be done as shown by Permit Number P20030648 has been completed. Tax Map Number. 523400-�308-014-0001-052-000-0000. Location: 183 PITCHER Rd Owner, ARC COMMUNITIES 14,LLC Applicant; FOREST MOBILE HOME PAR This structure maybe occupied'as a: By Order of Town Board Mobile Home In Park , Odd TOWN OF QUEENSBURY v Director of Building&Cade 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: P20030648 Application Number: A20030648 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 the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: AR.C4BFND, L.L.C. Mobile Home In Park $22,000.00 PROPERTY TAX DEPARTMENT Total value $22,000.00 PO BOX 13244 -EL PASO, TX .79913-3244 Contractor orBuilder's Name Address Electrical Inspection Agency Plans&Specifications 2003-648 3 GREGWOOD CIRCLE 16'X76' 2003 MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS $47.96 PERMIT PEE PAID-THIS PERMIT EXPIRES: Wednesday,August 18,2004 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the To,< ee�ns ay,August 18,2003 SIGNED BY the Town of Queensbury. Director of Building&Code Enforcement Application for Permit— Mobile Home Town of Queensbwy, 742 Bay Road, .Oueensbury, NY 12804 (518) 761-8256 A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a valid building permit has been issued. Applicant Information = Office Use 1(6I,, x Name: f-RC� 54 ts`) L-.>~.C. .ppti��-k��„�"�:.. Vr''"File Permit No. 3 IVP Address: e�t' 1�000 Fee Paid �7 Aug 08 2003 Reviewed By. Phone No. Q t1--5_9"7 r7 !,E:1 n G Y Property Owner Information Parcel Information !r0(ztST Proposed Date of Placement: '3 1 r7 Q 3 Name: ARcf 9PtJD i.-.L.0 . A/�JQ' -PT; ria n' j� Property Location: �'�}'eG1 _ C trG � Address: tvC)Q G�AN� 6T. �u lTE 9d0 Road,Street,Avenue "pEnl E 12 C.b 802...03-S E;2S Name of Mobile Home Park: I'oge,6T IRAw M E4C.. (if applicable) , Phone No. Sco 446 541 5 Tax Map Number: 30� Mobile Home Information Zoning Information Appro..imate Value of Home: S� T Zoning Classification: New Home: `Yes No _ � I '-�, Size of Property: ] ft.by `tC�$. Replacement Home: es No W►o1 t+ n t � � � nr^ Existing buildings: Sfif "6 C�erA Size of Mobile Home: t ttr ft. by �ft. hh Q Setbacks: front yard a i ft.; rear yard (, ft. Singlewide: Doublewide- Side yards_�ft.and_! Q ft. 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 A Woodstove%Wood Fireplace Attached garage: 1 car; 2 car, car Storage building: Yes No Foundation Support: Other: TYPE SIZE&DEPTH Water Supply. well or i6micipal e s Runners x Is Se tic Permit Required? Yes or No Slab x P e4 Further information requested on the reverse side of this sheet W Name of Installer or Mobile Home Dealer: of l Address: . Phone No. + Complete information below found on a"plate".or"sticker"which is affixed to the mobile home. 1. Insignia serial number_ 50 �5 2. Name of manufacturer. ma&1+C- L6 'l u- 3. Plan Approval Number: 4. Model or Component Designation: 4qq Y I (New Home ONLY) 5.. Date of Manufacture: Id lo-� AFFIDAVIT Town of Queensliury 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. Signature: owne'r,-ownei'j ag nt,architect,c5tramr Special Conditions of Permit By. Form: 11i1911999sn Code Enforcement Officer Town of (::Iuqeansbury Building 8L Code Enforcement 742 Bey Ftoawd Clueensbury, NY 12804 (518) 761-8256 -- L'>A'I'E Ii`�TSF'B.CT'I+CtN R.L-�C�LJI�S"T rREC�IVLI�: L. ATIG►N: r , M�►Sl;'Yol� ?l�i�li�� �56�>[>P�3.�.A>Ei. Ht7►1!r!E aF�v�s - FovNnATic�rt BAc-�r�L. �irrG 1_ f©undatic�n support, pier spacing per rnanuf- ------------------------ 2_ anclioririg per rri-al,uf_ -------------- 3_ water line shut-off ------------------- - 4_ sewer lime support <Zo 4 feet .------ 5. heating crossover (dblewide) off grd._ 6_ dryer vented outside ----------- ----------- ?_ slcrting ventilated -------------- ------ 8_ hot water relief valve piping outside - 9. J - la_ fur�.ce/hot water operating ____.___ 11_ garage Fire proofing ------------------ 12_ door closers ------- -- ------ -- ----- ----- 13_ plumbing fixture ---------------------- 14� fourtdatic)pn insulation cif appl_)--__-- 15_ smoke det+ectcors ----------------------- 16. fanal electrical ............. ........ ... variancerequired -------------------- - 1 8_. data plate o,"y ..... ...... ............ 19. mobile I:3UZ> seal okay ........ h+scidel # _ Serial. # 31►rtanufacturer Date: of manufactur+er Comments: - - Y � _ S _ ' W-=l"AXhA— lr%kMVMZ=M4=-jrl4=X" W*MI=CMXCMT�- N%ONC=31MIL-M -rc>wn of C)ua nsbury ......... Oui"injg 6k C;cxJc)k E,=nfc>rc4qmant 742 May F:kc>c-tcl Clue nsb-ury, MY 12804 (518) 761 -8256 I-js F": DATE ZNSPECTI©N REQUEST RECEIVED: I oor 1441/1AL 'VIPs 1*44c:> perxxiaxx-"f- ----------------- -- - ----- a-TxcAxc),ri-Txo Pw--T- rrmixily- ----------- - --- Vvatf--r ------ --- ---------- 4_ sewer lixxt-- support qV 4 feet ------- 6_ dryer vented outside -- -------------------- -7- SjCjrtjjjg ventilated - ----------- -------- I(v 11cpt vVatf--x- relief --r-al-ze pipirxg outside 9- C14--cJC, P<3Z-C--17Xf--S, Stf--PS, railing ---- --- - I vvatt--r <3rmaratt-II&Y ---- --- -- 11- gavgLB#-- fix-c-- prc>o-fi-rio ----- - --------- --- 1.2_ cic"3r <--l6st--rs - ----- -- ------------------- 13_ plumbing fix-ttil-t-- ----- -- --------_-___-- 14_ ftniridAticoxi insulatiorx Cii I-APPI-)...... 5r'� smoke detectors '+� fixial -cal - ---- ---- 17- ----- ---------------- 1S_ data PI.-Ltt-- ok.-:;Ly --- -------- ------------ 149- xxx423l:3il4-- 1413--EDo at--al okay -------------- Model # Sf--rial ff Manufacturer Date of 1%4nxxuf.-*c--tujr#--ir _,VIES- - - 1F■_ ElV�►� ■NSPECT■O�■ REPORT . , - _ n►/■OBl1LE--:/ MOio!<J■_AR--- - - - .` . . _ - -- - � - -row i CW Qugeenst>ury = Ouilclino 8� Co-d4a7 5=nfvrcermant _ "742 l3exv t=tcc:)ajd C:luerenst>ur"y, NY 12804 '(5:18) -761-8256- - - ARRIVE: DEPART: DATE INSPECTION, REQUEST RECEIVER: - DATE: f (C/ PERMIT #- - M�SILE E�i11bSE lbl�Q►1>r7<.TI..eA.1a. I-It7iME - FoMCxr n,-T"S FI. &MIlNC3 1_ foundation support, pier spacing per mariuf_- - ------------------- _ anchoring per zrianuf_ --------------- 3- water -line shut off ------------------- 4_ sewer Brie support Q� 4 feet ------- - - - 5_ -heatirig crossover (dblewide� off grd_ _ _ 6_ dryer vented outside -- --------------- - - 7- skirting ventilated ------------------- _ 8_ -hot water relief valve piping outside 9_ deck, porches, steps, rang ---___ -- -1 O_ furnace hot water operating ........ 1l. garage fire proofing ---- -------------- 1.2- do or c e losrs . ... .. . ........... ......... 13- plll!1"bing fixture .... . ............... .. 14. foundation. insulation (if appl.)...... 15- ---------------------- _ 16_ f. l ele+ctrical -----------------------. 17- var-iance required _____________ ________ 18- data plate c k.-Ay --------------------"--- i 9_ mobile HZ Tiff seal okay --------------- _ . Modei # Serial # Manufacturer - Date of Manufacturer C)KA'Y 'TC) ISSUE .C'!C) t��ilVA3._, !N'�G�EGT1iC3� RERORT _ - - N@nOmmlL-E l �ltQQULI�R - Tc3wn cif C�ue nsbury-- Building 8& (:::cxie Enfarc+amqant 742 E3 exy► Rc>a c l C)ucaonsbury, NY - 12804 (51 8) 76 1--8256 3 DATE INSPECT`I©N REQLJEST RECEIVED: - / 3 L !'�OCATION: v F ®�IYsE �I®1bYEApM®DUY,AIR H03� FCK7�TINCsS FOLTNI?A'TIQN SACK ILL FRAMING - NIA- YES NC.? 1_ fourachxtiorx support, pier spa.cirig perrnanuf. ... . ............ ...... - 2_ anchoring per rrsarxuf. .......... ..... ~- 3- water lirie shut off ------------------- / 4- sewer line support (ZD 4 feet _- _-_-- 5_ heating crossover �dblewide) off grd_ /// 6_ dryer vented outside -.-:--- - --------------- 7- skirtixzg vvantilated ------ ------- ------- 8- hot water relief valve piping outside 9. de:cic- porches, steps, railing --- ----- 1t}_ ; arx c(-_/hc)-t water operatirig. 11_ garage fire prcx::)fixig -------- ----- 12. door closers ._-- . ._ --- - -- - ------- - 13_ plumbing fixturc. .... . . . ......._.... .... 14- fciundation insulation (if aprpl.)---- -- 15. smoke Clete ctors .......... ........... .. . 16. final electrical ------------ ---------- -- 1'7- variance: required ------ --------------- 19. data plate okay - -------- -------- I9. mcibile HUD sea3 okay _-- -__--------- Model ## 0�1, Serial # Allanufa_cturer (AA_ Date of 3Viariufacturer �7 _t OKAY- T4c> ISSUE C/Q YES NCl E - � d REVIEWED BYZj r CIF DATE . VEy ' AUC;; O 20:03 OF QU�EN `ll,W46�r b� Ry FILECO. : t TOWN OF QUtENSBURY BUILDING DEPARTM i Based n oUr limited examination; r , co plia t"with our comments shall bbe nstrudd as indicating the Q� PInns td .a specifications are in full , COMPllaltft Watt the Building Codes i of Now Yefk State. `J 1. NOTICE.; _ t , ANCHORING OF MOBILE HOE TRANE'.IS REQUIRED PEF t MANIJFACITURERS SPECIFICAT IONS i. t • � C�, ' 1 ' N� s # q� t 1 --^� (A) t o c,I)2. 11Z