2002-914 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building,& Codes (518) 761-8256
BUIL. DING PERMIT
Permit Number: P20020914 Application Number: A20020914
Tax Map No: 523400-308-014-0001-052-000-0000
Permission ishereby granted to: CHRISTTNA MC CAT JT.TFFF
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 Budding Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: ARC4BFND,L.L.C. Mobile Home In Park
PROPERTY TAX DEPARTMENT Total Value
PO BOX 13244
EL PASO, TX 79913-3244
Contractor or Builder's Name Address Electrical Inspection Agency
Plans&Specifications
A
2002-914 Christina Mc Cauliffe, 15 Briwood Circle
- Forest Mobile Home Park
Installation of a 980 sq ft mobile home in Forest Home Mobile Home Community per plot plan and
specifications.
$33.80 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,November 05,2003
(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 n of Bens e a ovember 05,2002
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
RECEIVED
V ED
Application for Permit— Mobile Home OCT 2 8.2002
Town of Queensbury, 742 Bay Roac4 Oueensbury, NY 12804 (518) 761-8256 '''
TOWN OF QUEENSBURY
BUILDING AND CODE _
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: N)CkZ C\a mccnt�klrpz File Permit No.,;, "2--
o.,,"Z--
Address: j% ,_( 2tx 1 Za Fee Paid 53.16
�L1(t° QCa Reviewed By:
{a �}
..................................................._..............._..__ " ��;u E 1 V
Phone No. L' /,x� --C� -60C-1(o
Property Owner Information
Parcel lnformation OCT ! 8 2002
N OF
Proposed Date of Placement: I 1: d W Lp NG AND CODE QUEENSBURY
Name: R iz e +br } A ry, M W�
{� Property Location:
Address: I S3 �l Ithf r t�� Road,Street,Avenue
10� Name of Mobile Home Park: VoretCkyV,, M
(if applicable)
Phone No. (JCS)T57 Ito 1 Tax Map Number: _jQ1,5_
.Mobile Home Information Zoning Information
Approximate Value of Home: $ .
Zoning Classification: S V-.D
Now Home: Yes No
�Q� Size of Property: ft.by ft.
Replacement Home: Yes No
Existing buildings:
Size of Mobile Home: _�ft. by ft_
Setbacks: _front yard ft. ; rear yard ft.
Singlewide: _ Doublewide: Side yards ft.and ft.
Number of Rooms: (exclude baths)
Number of Bedrooms: A Accessory Building(s): circle
Number of Bathrooms:
Detached garage: 1 car; 2 car, car
circle: Gas Fireplace I 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 s
Runners Y is Septic Permit Required? Yes or No
Slab x
Further information requested on the reverse side of this sheet
i
;Name.of-installer or Mobile Home Dealer:
Address`.
Phone No.
Complete information below found on a"plate"or"sticker"which is affixed to the mobile home.
_. . I -Insignia serial number:
2. Name of manufacturer. G en3r
'-
'
Y t
3. Plati Approval Number
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4. Model or Component Designation: ] 7 �S)�
r (New Home ONLY)
5. Date of Manufacture: to " J 7 —9 1q
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 of the BUILDING CODE, the
ZONING ORDINANCE, and all other laws pertaining to the proposed work
shalt.be complied with, whether specified or not, and that such work is
authorized by the owner.
t
Signature: e \,,) �0 ("CZ
owner,owner's agent,architect,co�ntraUaY
t
Special Conditions of Permit
By:
Farm: 13/19/1999sh Code Enforcement Officer
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INS =
DATE INSPECTION FZEQL3FrST RECEIV = - - _ - - -
NA�tIE=
LOCATION= t -
UATE�= 7c- �
ik�48ILE Hi�ME M4I��3LA R HQME - ---
- IBC}C]�i['IN!GS F+L�►�[..,T�TL'�ATIC}iv BAt�7:G:]E�LLZ_.� --
1_ fcy�ac�sd�.taic supprsz-�t,. pi+�r s:p�ac i�zg
per xxaaxauf_ ________________________
2_ a�* ixorizxg per tz;azxexf ---------------
3_ water lixxe slta3t off -------------------
4_ sewer tame support (ZD 4 feet -------
S_ xeatisxg crossover (dblewide� off
S_ dryer vexxted outside -------------------
7_ skirt �g vtilated --------------------
S_ hvt water relief_ valve piping outside
-
11_ garage ftre pr+oofir�8 ------------------
•12_ doer; closers __-__-______-_______-_-_____
14- fcaxxxxdation ansulatiCnX 4Cif �appt_)l______
15_ smoke detectcxrs_ _-_____________________
1S_ fit;al clecirical -_-________________
IS: data plate cikay- -----------------------
-1-9_ mobile i�ISD seal _cskay -----------_-_
Model # Serial # - -
Manufacturer
Date c>f Manufacturer
- - +C3K.AY TO ISSIJ�- CI+O► _YE.'S- - - TIC7 --
Mir
InA 4=B l L.m=• or InA O 1=iJ LA Fm
_ Tc>wn csf Qua nsbury
Building SL CociB Enforo4sm4ent f
742 Bay► Ftcaaci �..'
Quo bury, NY 12804.
(518) 761-8258
ARRIVE- :E DEPART: � IN �
IDA71F-
INSPECTION REAL 7E.ST RECEIVEL7� ,+'"�
IIaA'I'E: � �/' �� '!� •�.-- PBI�.MIT # �_•'_.-
Ma!►SILE H®►7lt�lE 1�OI3tTLAE` Hfi!llY�E
FOOrTITTGS PGETNDATTON B.ACKFILL PR.AMING
NIA FSC�
1_ foundation support, pier spacing
permanuf- ------------------- --- ---
2_ aacHoriag -per kr an"f_ ----------- - ---
3_ water line sUixt off --------------_- -_-
4_ sewesr lixze suppbr-t (W 4 f--�t .... ...
5. heatixxg crossover �dblewide) off ,grd_ _=�
6_ dryer vented outside- -------------------
7_ s - tin ve tsl.-Ated -------------------- -
S_ t ter elief valve piping outside
9. deck, -Ut--S, steps, railing -------- -
ZC3. furtYace of water operating .___. _. .
11_ garage prcfirtg ---------------- --
doer lcise s - --- ------- --------------
13_ PI _ ing tu_re --------- - - --- --------
14. fo datican ulation (if appl_ . .. ...
15. sxno a detectors ---------------------- -
16_ final electrical ______ _________ _________
17_ variance required ----------- --- - ------
1S_ data plate okay -------------- ---------
19. mobile HLTD seal okay _________.-•_--
St-- *al # 1�
Mar�ufacturer - � �� ��
Bate of Manufacturer
QKAY TO ISSUE C/Q -YES. NQ
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OCT-3 --2002 10 :48 AM Fore:sLParkMHC 5187450808 P. 05
NOTICE
AN HORINO OF MOBILE H ME
I RAME IS REQUIRED P R
MAN FACTURERS SPECIFIC TIONS
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TOWN OF Q�1-E-�N� URY
BUILDING S
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REVIEWED BY r�-- to
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