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RC-0256-2023 w ' f�zS Office Use Only t MANUFACTURED HOME Permit#: (2C ' 02.5(Q • 2-0 2-:-2) --Tom of Quecns6ury PERMIT APPLICATION - Permit Fee:$ 221. 2� 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Rec Fee:$ rA Ps- yw-Al I Invoice#: Project Location: 8 East Ave, Queensbury, NY 12804 Flood Zone? Y Reviewed By4 H) Tax Map ID#: 309.9-2-26 Name of Park (if applicable): G C. PROJECT INFORMATION: Week of 5/29/23 or 6/5/23 L� I ET 1. Proposed Date of Placement: MAY 162. Approximate Value of Home:$$79,571 .00 FCVIisJ Di=0 X j r'jhY 3. Is the home NEW or a REPLACEMENT ? tLill�f� �t Ca �- X 131411 66' Roughly 885 4. Single-wide or Double-wide Size: ft.X ft.= total square feet S. Foundation support(choose one): Size Depth c Ue:,nq Placed Piers: 14'4"x67' ;n Sark Po5:1#_!er et5 ✓ Slab: �C:5 t;n�i �f►o rn e. X 6. Is the home being placed on a private lot? No Yes** (**if yes,you must provide stamped engineered drawings of the permanent foundation plan) 7. Total#of rooms(exclude bathrooms): 6 ;#of bedrooms: 3 ;#of bathrooms: 2 8. Additional heat source? No Fs i YesEi Choose one, if yes: gas fp❑ woodstove11 wood fpF 9. Are there any other/existing buildings on the property? NoF1 Yes, ✓, Explain:Small addition (Demo) 10. What is the water source? PUBLIC F y l PRIVATE WELL n 11. What type of wastewater system is on the parcel? SEWER II PRIVATE SEPTIC 12. Do you need a septic permit application? No II Yes Z(if yes, please submit separate septic application) MANUFACTURED HOME INFORMATION: *Stone Industries will be pulling permit and completing work (INFORMATION FOUND ON THE PLATE OR STICKER LOCATED IN THE HOME): Insignia serial #: Name of Manufacturer: Champion/Atlantic Place approval #: Model or component designation (New Home Only): Date of manufacture: Manufactured Home Application Revised July 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): Showcase Homes of Malta (Joshua Hala) Mailing Address, C/S/Z: 2651 Route 9, Malta, NY 12020 Cell Phone: )518-223-5045 Land Line: _)518-580-1305 Email:joshhala@shohomes.com • Primary Owner(s): Name(s): JoAnn Gregory Mailing Address, C/S/Z: 8 East Avenue, Queensbury, NY 12804 Cell Phone: )518-225-5276 Land Line: �) Email: ❑ Check if all work will be performed by the property owner only • Contractor(s): (List all additional contractors on the back of this form) Contact Name(s): Showcase Homes of Malta Contractor Trade: Retailer Mailing Address, C/S/Z: 2651 Route 9, Malta, NY 12020 Cell Phone: _)518-223-5045 Land Line: )518-580-1305 Emai1:joshhala@shohomes.com "Workers' Comp documentation must be submitted with this application" Contact Person for Compliance in regards to this project: Joshua Hala or Adam Hala Cell Phone: _( )518-223-5045 Land Line: _( )518-580-1305 Email:joshhala@shohomes.com 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: Joshua Hala SIGNATURE: DATE: 5/5/23 Manufactured Home Application Revised July 2022 CIRF IPF Deed Reference: Marilyn Gregory To James A. Gregory And Jo Ann Gregory Dated: December 21, 2015 Book:5290 Page:77 1.) THIS MAP WAS PREPARED WITHOUT THE BENEFIT OF AN ABSTRACT OF TITLE OR AN UP TO DATE TITLE REPORT AND IS THEREFORE SUBJECT TO ANY STATEMENT OF FACTS SHOWN THEREON. 2.) NORTH ORIENTATION IS PER NEW YORK STATE PLANE EAST ZONE, NORTH AMERICAN DATUM OF 1983 (NAD83). BEARINGS SHOWN ARE REFERENCED TO THIS DATUM AND THEREFORE MAY NOT MATCH RECORDED BEARINGS. 3.) PARCEL IS SUBJECT TO ANY EASEMENTS OF RECORD. 4.) THIS MAP WAS PREPARED FROM AN ACTUAL FIELD SURVEY MADE IN ACCORDANCE WITH THE EXISTING CODE OF PRACTICE ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS. 5.) THIS MAP IS COPYRIGHT © 2023 VAN DU5EN 4- STEVES LAND SURVEYORS. UNAUTHORIZED ALTERATION OR ADDITION TO THIS DOCUMENT IS VIOLATION OF SECTION 7209, SUBDIVISION 2, OF NEW YORK STATE EDUCATION LAW. G.) DIMENSIONS BETWEEN PROPERTY LINES AND STRUCTURES ARE TO THE NEAREST HALF FOOT AND ARE FOR THE SOLE PURPOSE OF INTERPRETING THEIR CONFORMANCE WITH ZONING AND NOT INTENDED TO AID IN THE ESTABLISHMENT OR RETRACEMENT OF PROPERTY LINES. 7.) UNDERGROUND UTILITIES, IF ANY, ARE NOT SHOWN HEREON. 8.) THE SURVEYED PARCEL IS SUBJECT TO WHATEVER RIGHTS, TITLE OR INTEREST THE TOWN OF QUEENSBUKY AND THE PEOPLE OF THE STATE OF NEW YORK MAY HAVE TO MAINTAIN THE ROADS, AND TO WHATEVER RIGHTS, TITLE OR INTEREST THE TRAVELING PUBLIC MAY HAVE TO THE BED OF THE ROADS. an D u s e Steve s Land Surveyors 169 Haviland Road Queensbury, New York 12804 '518) 792-8474 New York Lic. No. 50135 Lands of Viola Celeste B:5366 P:250 309.5-2-27 'UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEARING A LICENSED LAND SURVEYORS SEAL 15 A VIOLATION OF SECTION 7209, 5UB-0IVI5ION 2, OF THE NEW YORK STATE EDUCATION LAW.' 'ONLY COPIES PROM THE ORIGINAL OF THIS SURVEY MARKED WITH AN ORIGINAL OF THE LAND 5URVEYOR5 SEAL SHALL BE CONSIDERED TO BE VAND TRUE COMES.- 'CI!KnMCATION5 INDICATED HEREON SIGNIFY THAT THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE UL5TING CODE OF PRACTICE FOR LAND SURVEYORS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS. SAID CERNBCATION5 SHALL RUN ONLY TO THE PER5 N FOR WHOM THE SURVEY 15 PREPARED, AND ON HI5 BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION U51ED HEREON, AND TO THE A551GNEE5 OF THE LENDING INSTITUTION. - pock 5pTke O 3 0 � m O 20 5'± Ga O x IRF FINAL SURVEY N 82°25'53' E FED 0.00, 309.9-2-2G6000 Sq. Feet 0.14 Acres 100.00, s s2°2 Lands of Lawrence Henderson 8:5381 P:146 309.9-2-25 Map of a Survey made for Showcase Homes Town of Queensbury, Warren County, New York 2"2�E 67.03' 309.9-2-23 3351 Sq. Feet co 0.08 Acres N � N 41 N y %Aj Shed � S 82°25'53" W D f ---_ AU 10 T SIN �f� .DEEPJSgDRY CODES P-Q-0Z!�>(--a-Za �)C�SV 71\-VC7 NO. I DATE DESCRIPTION legend: IPF = IRON PIPE FOUND IRF = IRON ROD FOUND CIRF = CAPPED IRON ROD FOUND = UTILITY POLE rti '(J = FIRE HYDRANT Date: July 24, 2023 Scale I "= 20' S-1 SHEET 1 OF 1 SHOWCASE HOMES DWG. NO. 23-1 G5 C-3906 309.9-2-23 * 2G