2000-371 A .,1/v+' .yv l . •,.i N.^ti.s •.r 'l'r, `.`tr'^i! v k if r�
nC,e f a e rtl ,lc ^ t '
' 1 i
'own of Queensbury
Warren County, New Fork
2000371
This is to certify that work repested to ba done as shown by Permit No,
has been completed,
This structti,re may be occupied as a . MOBILE HOME
Location LOT 4 PETRIE LANE
Y/fnY+4 PT
.... r-..........w+n,-rw
f
TAX MAP NO. 121.4-594 By Order Town Board
OF U r
Director of Building& Code Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 37000 Building Permit No. 2000371
TAX MAP NO. 121 . -6-59. 2
Permission is hereby granted to CLARK, CAROL & PATRICK
Owner of property located at LOT 5 PETRIE LANE
in the Town of Queensbury,to construct or place a MOBILE HOME
at the above location in accordance to 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.
Owner's Address:
LOT 5 APRIL LANE
QUEENSBURY, NY 12804
Contractor or Builder's Name:
GLENS FALLS MOBILE HOME INC.
Contractor or Builder's Address:
39 SARATOGA RD
GANSEVOORT, NY 12831
Electrical Inspection Agency:
NEW YOR.K BOARD
NEW YORK BOARD OF FIRE UNDERWRITERS
Type of Construction:
MOBILE HOME
Plans and Specifications:
1216 SQ FT MOBILE HOME AS, PER PLOT PLAN SPECIFICATIONS
Proposed Use:
MOBILE HOME
47 June 6 2@@2
$ PERMT FEE PAID-THIS PERMIT EMPIRES
(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.)
6 June 2000
Dated at the Town of Queensbury this Day of
SIGNED BY _�� e�Q.C4.,vi f for the Town of Queensbury
Code Enforcement Officer
Application for Permit— Mobile Home
Town of Queensbury,.742,Bay Roam Quefnsbury, 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.'
�lppli t Information
Office tTs&
Name:�-1��� -t°(q t File Permit Nq,9X4-3!J
l
Address:001
Fee PaidIVED
-2-� i •,
rn
.Us r UjILA Reviewed By: V
r a-8o
Phone No. 62- 5 ;3gol
Parcel Infoi ri iL" ,W G
Prc jWY -Owne>Tormation
Name:
Proposed Date of Placement:
� _
Property.Location: O I ,
Address: _ Road,street,Avenue
Name of Mobile Home Park: �.• ie �
_. l ; if applicable)
Phone No. Tax Map Number: _1�'/ / 59,01-1
Mobile Home Information Zoning Information
Approximate Value of Home:$ -3 r7,6(90
Zoning Classification: inby .
9�
New Home: Yes No
Size of Property:
Replacement Home: Yes
Existing buildings:
Size of Mobile Home: 1 ft. by -7 =� ft.
Setbacks: front yard ft.; rear yard ft.
Singlewide: Doublewide:: Side yards ft.and ft.
Number of Rooms:(exclup baths) k
Number of Bedrooms: Accessory Building(s): circle
Number of Bathrooms:�—
Detached garage: 1 car; 2 car, car
circle: Gas Fireplace or Woodstove Attached garage: 1 car; 2 car, car
Storage building: Yes No
Foundation Support: other:
TYPE SIZE&DEPTH Water Supply. circle
Piers
Rurmers
Slab well ; municipal
Further information requested on the reverse side of this sheet
IF=lr4 .Ak2_ iEis"V �►i�.�CTiEGi� �Ri�POf T
P4/ii CMI M I L i= / r+w#v Ol=V LA FM -
Tc3w►n- of C�ueensk3ury
Building Ek Codia Enfc)krcament _
742 E3ay F3oad
C3ue�nsbury, NY 12804 ,r
(51-8) _761-8256 1
ARRIVE:�� DEPART: IiVSP- c- _
Z7A"T� INSPE.CTIt'�N RFQL7FS'I' R�+CEIv
NAIVE E: '
LOCATION:
lrff®SIILE I-�LiiRriE MO�UL�R Ht�+ME
FOOTINGS FOUNI3AT`ION BAG�KFILL FRARrIII'�iG
' - N/A. 'YES NCI►
i_ foundation support, pier spa r--ing /
per rnanuf ------------------
_ anchoring per znanuf. .__.._ ......
3_ water line Shut off ------ --- ----- ----
4_ sewer line support @? 4 f t . ....
5. heating crossover {dble �deb off rd_
Z
7- skirtingven a
tilted ---- --------8- riotwaer
t relie a
f vlve iping oside
9. deck, parches, steps, ailing ......
10- furriaces/hot water o ratin
21_ garage fire proofing --- ----- - - ----
12_ door clews ._ . . . . ._ ---------- - --
23_ plumbing fiixture -- ----- ---- ------ --
14- foundaticorx i-Isulatica (if appl-)- -----
IS- smoke detectors --_ -------------- --- -
16_ final electrical ---- ---- -- - - - ---------
1'7_ variance required - ------------ -------
18- data plate okay ---- --- -- - - --------- - -
19_ mobile HLTD seal y ----- --------- i
McKlel # Serial
IVlanufac Curer
C3KAY TO ISSUE C/C)O YES NCB
Name of Installer or Mobile Home Dealer:
Address:
Phone No. c5 J 8 ! 7E
State of New York Division of Housing& Community Renewal
Insignia of Approval of the State Building Code
Complete information below found on a"plate`!,'or,"sticker"which`should be affixed'to the
mobile home:..
1. Insignia serial number: � �Dl
2. Name of manufacturer:
3. Plan Approval Number :
4. Model or Component Designation: t 6k 7�
(New Home ONLY)
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 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: poz C�911f_
-
owner,owner's agent,architect,contractor
Special Conditions of Permit
By:
Fonn: 11n8i1999sh Code Enforcement Officer
�a 4oT
LTI
NOTICE I ECOPY
`; �NCNORING OF MOBILE
wa Is REQUIRED
kNuf�CTURERs specific JIONS F UEENSBURY
. � TOWN � Q
BUILDING& PT.
1
REVIEWED BY
DATE
A�
J TOWN Qc QNEENRURY BOX`DEPARTMENT
V Based onour limited examination,
complianceuh our commmet shaii
plans and specirutions are in M
compliance with the code,
Glens Falls Mobile&Modular Homes iL
39 Saratoga Raad,Gausevocn, K.Y.'-12B31
$ $ WS
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