RC-0347-2023 Office Use Only
MANUFACTURED HOME Permit#: UPS
PERMIT APPLICATION
Town of Queensbury 2
742 Bay Road,Queensbury,NY 12804 I
E C E :$ )�
P:518-761-8256 www.gueensbury.net
JUN 16 202 1 i : �� ab i r
r
TOWN OF QUEENSBURY
tt nn � 11 BUILDING&CODES
Project Location: `- '� � � ��'1/v� Tax Map ID #: • �—
Name of Park: ee Proposed Date of Placement: 5
CONTACT INFORMATION:
• Applicant: S t . 4PS C�ND�
Name(s): W
Mailing Address, C/S/Z: _2uD 05P ELT' 0,y, 2�3
Cell Phone: 57 I ) Land Line:
Email: 9 14c>meeo , vV(-
• Primar Owners : .'') 1
Mailing Address, C/S/Z: D 2a E; e C PAR: (
Cell Phone:�'�)`f Land Line: ( 5TV
Email: ---��
• Contractor(s): ) )
Business Name: Fiq ( IS M®b),l C'_ a� iV C
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: �_) Land Line:
Email:
Contact Person for uilding & Code Co�myliance: J t�/`-
Cell Phone: ,5 )� ) `�°�� D `� 'Land Line: r I ) r '7G$rZ92>1
Email: D TA e
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017
a
MANUFACTURED HOME INFORMATION:
(INFORMATION FOUND ON THE PLATE OR STICKER LOCATED IN THE HOME):
Insignia serial #: PrDO 5_9 1 t7 P
Name of Manufacturer: 'dacll� 1 r)
Place approval#:
Model or component designation (New Home Only):
Date of manufacture:
ADDITIONAL INFORMATION:
1. Approximate Value of Home:$ I'4 C)l UO2 , DQ
2. Is the home NEW I*k or a REPLACEMENT ?
3. Single-wide or Double-wide� Size: X 626 ft.
4. Foundation support(choose one): Size Depth
Piers: lJe��g11�(—
Slab:
5. Is the home being placed on a private lot? No_X_ Yes (if yes,you must provide stamped engineered
drawings of the permanent foundation plan)
6. Total#of rooms (exclude bathrooms): #of bedrooms: #of bathrooms: IPIL _
7. Additional heat source? No—L Yes Choose one, if yes: gas fp_ woodstove_ wood fp_
8. Are there any other/existing buildings on the property? No_)�, Yes ; Explain:
9. What is the water source? PUBLIC PRIVATE WELL
10. Is the parcel on SEWER or a PRIVATE SEPTIC system?
11. Do you need aseptic permit application? No_)�,_ Yes
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 completed with
I have read and agree to the above:
PRINT NAME:
SIGNATURE: DATE:
Town of Queensbury Building&Code Enforcement Manufactured Home Application Revised May 2017
X:IENGVIdantic Divi5ion4SALES SPECULATIOM122-07-A-24402-From SN5875.8t1 Porches-Omit Berl 3-Shelly-Glenn-Parker-4-20-23-CL.dwg,4/21/2023 920;13 AM,DWG To PDF.pc3 �—
TYPICAL PIER PRINT DESIGN CRITERIA: NOTE:ALL DROPS SUBJECT TO CHANGE UPON COMPLETION OF PRODUCTION PRINTS
ONE INCH MAY NEED TO BE ADDED TO THE WIDTH
1.THIS PRINT HAS BEEN DERIVED FROM D.A,P.I.A. APPROVED DESIGNS OF THIS HOUSE UPON TFIE USE OF OPTIONAL
FOR REVIEW ONLY
2.REFER TO THE APPROVED INSTALLATION MANUAL FOR THE FOLLOWING: O.S.B.SHEATHING ON THE MATEWALL.
A.SITE PREPARATION
MANUFACTURER DISCLAIMER NOTICE B.SOIL BEARING CAPACITY
PLEASE READ AND UNDERSTAND THE FOLLOWING INFORMATION C.FOOTING DESIGN AND SIZING SITE DETAILS:(TO BE COMPLETED BY ITT-INSTALLER)
CHAMPION HOME BUILDERS,DOES NOT PERFORM ANY SITE WORK FOR HOMES D,PIER CONSTRUCTION
IT WILL BE THE RESPONSIBILITY OF THE OEALERISITE CONTRACTOR TO(INSURE E.ANCHORING SOIL BEARING CAPACITY:
THAT ALL SITE WORK WILL CORRELATE WITH THE UNIT ORDERED. 3.THIS PIER SUPPORT DESIGN HAS BEEN CREATED SPECIFICALLY FOR THIS SERIAL NUMBER FOOTING SIZE.—__ALL DIMENSIONS SHALL BE VERIFIED BEFORE CONSTRUCTION. 4.PIERS ARE REQUIRED AT BOTH SIDES OF EXTERIOR DOORS IN LOAD BEARING SIDEW WALLS,( —
NOTICE TO ALL HOME INSTALLERS;MANUFACTURED HOMES WEIGH SEVERAL PIERS ARE NOT REQUIRED IN NON LOAD BEARING END WALLS).-PIER SUPPORT ALTERNATE- FOOTING SPACING:
TONS,DO NOT ATTEMPT TO INSTALL HOME ON SITE WITH OUT HAVING DAPIA PAGE FLO1.06.01(MAY ONLY BE USED ON DOORS LESS THAN 48'WIDE). (COMPLETE ONLY IF DIFFERENT FROM SHOWN)
EXPERIENCE,KNOWLEDGE AND UNDERSTANDING OF ALL INSTALLATION 5.BLOCKING IS ALSO REQUIRED AT BOTH SIDES OF OPENINGS 48'OR LARGER IN LOAD BEARING
REQUIREMENTS,FAILURE TO MEET THESE REQUIREMENTS MAY RESULT IN SIDEWALLS OR MATE WALLS. PIER LON):_-- _
SERIOUS INJURY OR DEATH TO AN INEXPERIENCED INSTALLER.III-EASE READ MARRIAGE LINO PIER LOADS.
AND UNDERSTAND THE SET-UP AND INSTALLATION MANUALS SUPPLIED WITH f FRAME SUPPORT POINT LOAD SUPPORT TI 1181IOME BEFORE ATTEMPTING INSTALLATION OF ANY MANUFACTURED I TOME. L---J ■ A
SHELLY 4-20-23 ---- °--------
GLENN FALLS - PARKER WATE45
R[NLET TOWN OF QUEENSBURY
REV.4-21-23 BUILDING & CODES DEPT.
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ES SEX
Engineering Science&Subsurface Exploration,P.C.
1120 Vaughn Road
Hudson Falls,NY 12839
Telephone 518-798-1878
Facsimile 518-798-4748
July 13, 2005
Mr. Sam Wahnon
Glens Falls Modular Homes
1304 Rt. 9
Gansevoort, NY 12831
Foundation Design
Queensbury Village Mobile Home Park
Tax Map No. 121-6-59
Petrie Lane, Queensbury, NY
Dear Mr. Wahnon:
Enclosed is our recommended foundation design for manufactured housing at
Queensbury Village Mobile Home Park, Tax Map No. 121-6-59, Petrie Lane,
Queensbury, NY. If you request and we provide specific written authorization, you may
use the design at other locations where, in our sole professional engineering judgement,
the soil, groundwater, structural and climate conditions are suitable.
This design was prepared to address the current Residential Code of New York State
which requires .in part that manufactured housing be supported by foundations that_
extend below the frost line unless udesigned so that it will otherwise be protected from
the effects of frosts.
In our professional engineering judgement the intent of this requirement is to protect
property from the effects of non-uniform upward movement due to frost heave and non-
uniform downward movement due to loss of support when frost heaved soil thaws.
Please note that freezing and frost heave are two distinct phenomena. Soil commonly
freezes without heaving. When this occurs there is no noticeable movement of the soil
surface or of structures supported by the soil.
When certain soils freeze under certain conditions they heave because substantial
masses of ice accumulate within the soil. When this ice thaws the resulting water
causes the soil to lose strength. Frost heave can occur only when three conditions exist:
• The soil is of a type that is frost heave susceptible
• An ample supplyO water is available a shallow depth below the ground surface
• The soil temperature is below the freezing point at the ground surface
Delanson, NY Malta, NY
51 895 8846 518 899 5377
s
Mr.' Wahnon 2 July I3,2005
To be susceptible to frost heave, soil must consist of particles that are fine enough to
allow water to rise by capillary action from the groundwater level to the freezing soil.
However, the soil must be coarse enough that a substantial quantity of water can be
delivered to the freezing soil. In general, silt-size particles are the most susceptible to
frost heave. Coarser soils such as sand and gravel do not allow capillary action and
finer soils such as clays (or other soils that contain much clay) are too impervious to
allow a significant amount of water to reach the freezing soil.
Frost heave can occur only when groundwater is available in sufficient quantity, close
enough below the freezing soil to be conveyed to the freezing soil by capillary action.
The maximum theoretical height of capillary rise is about 30 feet. The actual maximum
height of capillary rise that can deliver an adequate amount of water to cause frost
heave is significantly smaller.
Frost heave can occur only when the ground surface remains below`the freezing
temperature of water for a significant period of time. Otherwise ice cannot accumulate in
the soil in a large enough mass to cause heave.
At Queensbury Village Mobile Home Park you arranged for the excavation of a test hole
to a depth of approximately six feet and we observed the soil conditions on June 29. We
classified the soil as: brown, moist, well-graded fine to medium-grained sand with trace
amounts of silt. We identified this soil as a deltaic deposit associated with Glacial Lake
Albany. The potential for frost heave in well-graded sand is none to very slight.
Therefore, this soil is not subject to significant frost heave, even when the groundwater
and temperature conditions for frost heaving are met.
Our observations of the moisture condition in the test hole and our review of sources of
geologic information indicate with a reasonable degree of confidence that there is no
sufficient supply of water within the maximum height of capillary rise below the ground
surface at Queensbury Village Mobile Home Park. Even if the soil were frost heave
susceptible, the potential for frost heave would be limited by the availability of water.
Queensbury Village Mobile Home Park requires skirting to enclose the space below .
every home and the foundation piers for the homes are set back inside the skirting. The
skirting provides some protection against outside temperature extremes. Research
conducted for the Ohio Manufactured Housing Association indicated that the space
enclosed by skirting was approximately 20 degrees Fahrenheit warmer than the average
outside temperature. during one Ohio winter. In Ohio this was enough to prevent
freezing for most of the year. At Queensbury Village Mobile Home Park the skirting
probably limits the depth of freezing to one to two feet whereas the frost line applicable
to perimeter foundations would be about four feet below the ground surface. Therefore
the skirting would also tend to reduce the frost problem even if the soil was frost heave
susceptible and the water supply was ample.
As a result of the particular subsurface conditions at Queensbury Village Mobile Home
Park described in this letter, it is our professional engineering opinion that a shallow
foundation system is'"protected from the effects of frost".
f
Mr Wahnon 3 July 13,2005
Based on the particular conditions at Queensbury Village Mobile Home Park we
recommend that each foundation pier for new installations in the community bear on a
21-inch square ABS plastic mat designed and manufactured for the purpose of
supporting manufactured home piers. (Refer to the enclosed drawing.) Foundation
piers should be located at eight to ten feet on center along each frame rail of each
manufactured home. This recommendation is based on our understanding that a 14 by
70-foot manufactured home unit weighs approximately 40,000 pounds plus snow load.
Where fill is required beneath the pier foundations we should be retained to develop
specific fill specifications consistent with the recommended foundation or to recommend
an alternative foundation. Piers and ground anchors should be sized and constructed
according to the recommendations of the home manufacturers.
We appreciate the opportunity to work with you.
Sincerely,
ames L. Wood, Ph.D., P.E.
Principal
Encl.
............ .................... ...........
Wind Zone I
Patent#6622-139
Anchors,:
Installation Instructions for Model LLBS Longitudinal and
Lateral Bracing%gdeirn Zones I
The LLBS Is not designed to be used as a supporting pier.
Note- Your set must be designed by a Registered Professional Engineer if the following conditions
occur:
Location is within 1,500 feet of Coast Roof eaves exceeds 16'
Pier Height exceeds 48" Main beam spacing exceeds 99.5'
Sidewall height exceeds 96"
I Refer to the Home Manufacturer Installation Instructions for pier locations. Referto the home
manufacturer Installation Instructions for required fooling size and pier spacing. Note: SD3
pad is2,8 sq.Ft. Vertical Sidewall and Marriage wall anchors maybe required by the home
manufacturer when usingthe MMA LLBS systems, See Manufacturer's Instructions.* Max
Pler Height 48"
2 Refer to the Systems Placement Plans for the location of Longitudinal Lateral Bracing system.
(See Attached)
a Remove turf to expose firm soil at each SD3 pad location, Install SD3 pad to manufacturer,
stale,local codes,and frost line guidelines as it may apply. For extremely hard or rocky soil,
mark four(4)slots and pre-drill soil with a 3/4 x 12"masonry drill.
4 Attach tube clip to SD3 pier pods(see Detail Assembly Drawing)center pad under beam,
level pod. Angle Drive Pins may be driven vertically through four(4)slots in SD3 pier pad now
or after home Is totally set. Angle drive pins may be driven up to ten degrees(10)off of
vertical. If you choose to drive pins after home is set,do not cover slots in pier pad.
5 Level home on concrete blocks or steel pier by Minute Man.
6 Install Longitudinal and Lateral Bracing in accordance with System Placement Plan and
Detail Assembly Drawing.(I longitudinal brace tube per system In Wind Zone I only).
7 3,150 lb.Working load anchors with stabilizers and frame ties are required on 4 corners of all
single wide homes.
a Special Instructions: Alabama;LLBS Systems approved for maximum 32'pier height
Thank you for using Minute Man Products,Inc. If you have any questions, please call Toll
Free at(800)438-7277,
305 West Kinq St. East Flat Rockorth Carolina 28726
.......... ........................ , N ....................
........
j:::::::::..:: .................:::::.::::::::::_::.:.-:c::::.:::..::..:.::::::.::_::::::::::.:.:::::.::::.:..::.:._..:::::::.:::_...:..-::r.:::-.:::.::::
i'
I ZONE I LONGITUDINAL AND LATERAL BRACING
SYSTEMS PLACEMENT
i
I!
Vertical sidewall and marriage wall anchors may be required by the home manufacturer when using the I'
MMA LLBS system,see the manufacturer's instructions. 3,150 lb.Working load anchors with stabilizers and 'I
frame ties are required on 4 corners of all single wide homes, Systems must be as equally sp
!iaced as �!
possible, (Triple wides and tag units require 2 additional systems, Place additional systems at the corner II
„ ends of the e>posed side of the home.)
I
Ij HOME DIMENSIONS REPRESENT BOX SIZE-FOR HOMES OVER 80`CALL MMA
I 4 Longitudinal Anchor w/stabB¢er Lateral Bracing Sysem �{.Longitudinal and Lateral
Bracing System and frame tie Y Bracing System locarions
4112 ROOF PITCH
------
40
x
I
O ! O
' O b ' i i b
IiE
I I ,
SINGLE WIDE HOMES DOUBLE WIDE HOMES SYSTEM LOCATIONS FOR II
I UP TO 76'LONG-2 SYSTEMS UP TO 76'LONG-2 SYSTEMS SINGLE&DOUBLE WIDE HOMES
76-80'LONG-1 ADDITIONAL SYSTEM 76'-80'LONG-1 ADDITIONAL SYSTEM USING 3 SYSTEMS I
I
! it
' LLBS System Requirements for roof pitches over 20°with 8'Sidewalls
ji tlaai5s iRacfFlcRRgiaeof5[oii + ?ra. i Mir
32=4 s2 I
`?ft-- 2207 ;2Tra ° Witt
li 34' 2 2 2 2 2 58'
36' 2 2 2 2 2 60` :3Y ;v 3=_ -3;? (!
i 38' 2 2 2 2 2 62'
I 40' 2 2 2 2 2 64` :3 -. "<3 .. 3 s- 3 4
li 42' 2 2 2 2z 66' x = _`3°, 4 4 is
44' 2 2 2 :z$ i -^ ;=„: 68' :3'`;x =,T3 3 4 4 I'
I 46' 2 2 2 ;::3 `n 3-x<„c: 70' asE3Es3%cE' 4 4 4
48' 2 2 '3.. 72' ;3 Y 3,: 4 4 4
I; 50 2 746 _ 3 4 4 4
52' 2 76' `xr�3 '. .,:.4.. 4 4 4
54' 3= 78' >'` 4 4 4 4 i t
56' 3%a 3' - z`3_`; '=3" s 80' ;g;x 4 4 4 4
Call Minute Man Products for system requirements on homes with g'Sidewalls
,
t.........._...._._._.__....__...._.............._........=--.-...._......................................._.....--
2
LATERAL BRACE FLEX TUBES FOR CONCRETE
--------------------------------------------
UPPER SECTION
----------------------------------------------------------
0 0
LOWER SECTION
LONGITUDINAL BRACE FLEX TUBES FOR CONCRETE
TOP VIEW
Length Varies with Pier Height SIDEVIEW
10,
LATERAL BRACE DETAIL LATERAL CLAMP
FOR SD3 PIER PAD ASSEMBLY
J" x 2-4" GRADE 5
CARRIAGE BOLT, INSIDE HOME
NUT AND WASHER FRAME BEAM
WASHER
4 4 A4" SELF DRILLING
SCREWS — 2—EA. SIDE
INSTALL AFTER HOME 1 Y" 0 TUBE
IS SET AND ALL OTHER 60" FOR 99.3" MAX. SPAN
BOLTS ARE TIGHT
LATERAL TUBE CUP 1 3�" TUBE
60" FOR 99.5" MAX. SPAN
h'x2 yh"
CARRIAGE BOLT O MAX 45' (ANGLES FOR BOTH LATERAL&LONG(fUDINAL BRACE TUBE.)
MIN 90°
ANGLE DRIVE PINS MAY BE DRIVEN UP TO TEN DEGREES
(10)OFF OF VERTICAL IF YOU CHOOSE TO DRIVE PINS
1/2" HEAVY DUTY WASHER AFTER HOME IS SET,DO NOT COVER SLOTS IN PIER PAD.
W/ 1/2-xi-1/2- CARRIAGE BOLT -10 LONG PINS MAYBE USED IN CLASS III AND II SOILS.
•16"PINS ARE REQUIRED IN CLASS 4 SOILS.
LONGITUDINAL BRACE DETAIL FOR SD3 PIER PAD
OUTSIDE HOME BEAM
MMLBC BEAM CUP
W/ 4 h.xi)r
CARRIAGE BOLTS
3l"x2—X NOTES
CARRIAGE SOLT
MAXIMUM PIER HEIGHT 4$"
1 3X2" 0 LONGITUDINAL MAX. SIDEWALL HEIGHT 96"
BRACE TUBE
MAX. BEAM SPACING 99.5"
2— 39" FOR 12" TO 24' PIER
2— 44' FOR 12" TO 32" PIER MAX ROOF EAVES 16"
2— 53" FOR 12" TO 40" PIER
2— 65" FOR 12" TO 48" PIER NOTE; 1f2" BOLTS ARE GRADE 5
1¢"x2 34` CARRIAGE BOLT WHEN USING LONGITUDINAL, BRACES,
2ND PIER IN FROM THE END
OF THE HOME MAY BE USED
TO MAKE ROOM FOR BRACE TUBES.
SD3 PIER PAD
LONGITUDINAL & LATERAL BRACING SYSTEM
DETAIL ASSEMBLY DRAWING
6"M
1NSt0E 1404EAM C
TERAL ADJUSTABLE
BRACE TUBE
C F.Caicc3el,P.E.
[: Fe9ijWr6drEngineer
r jp BLOCK OR
'�• ,,, ,,,,., DEL.UX STEEL
LONGITUDINAL PIER LIP UP
BRACE TUBE
STEEL PIER PAD
The Minute Man Anchors LLBS W1 ANGLE DRIVE
Bracing System was tested for PINS SD 3 DRIVE PIN
Wind Zones I,II,&III
Tested i0J10/01
Rev.316/02 3,150 lb.WORKING LOAD ANCHORS WITH STABILIZERS AND FRAME
Rev.7/14104 TIES ARE REQUIRED ON 4 CORNERS OF ALL SINGLE WIDE HOMES.
Rev.2/1!1 D ANCHOR STRAPS MAY BE INSTALLED WITH AN ANGLE AS LOW AS
45 DEGREES UP TO 90 DEGREES WHEN THEIR SOLE PURPOSE IS
Rev.1/1/15 VERTICAL ANCHORAGE.
LLBS Longitudinal and Lateral Bracing System engineering certification for
Wind Zones I, II & III, ground and concrete applications.
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A 19:I IM12
FOUNDATION PLAN
21" SQUARE
ABS PLASTIC MAT
(See Note 6)
PIER ELEVATION r---------�r---------�
I. I
I
. I I
II
II I
L--------- ---------J—
vO i i
CMU Pier
am
No•60 Tamped Sand Subgrade
�Rt7fFS S IU,a��
NOTES:
1. THIS FOUNDATION DESIGN APPLIES TO SPECIFIC SOIL,GROUNDWATERAND INSTALLATION
CONDITIONS FOR MANUFACTURED HOMES INSTALLED AT QUEENSBURY VILLAGE MOBILE HOME
PARK,PETRIE LANE,QUEENSBURY,NY 12804.
2. THIS FOUNDATION DESIGN MAY NOT BE APPLIED TO ANY OTHER LOCATION WITHOUT SPECIFIC WRITTEN AUTHORIZATION OF ESSEX
3. LOCATE PIER FOUNDATIONS 8 Ft.TO 10 Ft.ON CENTERALONG EACH FRAME RAIL ORAS RECOMMENDED BY MANUFACTURER.
4. DAMPEN(DO NOT SATURATE)AND TAMP ALL SOIL SURFACES TO RECEIVE PIER FOUNDATIONS
5. PLACE ONE 21-INCH SQUARE ABS PLASTIC MAT MANUFACTURED FOR THE PURPOSE OF SUPPORTING MANUFACTURED
HOME PIERS OR SUBSTITUTE APPROVED BY ESSEX.
6. PLACE CMU PIERS AND SHIMS AS REQUIRED ACCORDING TO HOME MANUFACTURER RECOMMENDATIONS
7. GRADE SOIL TO DRAIN AWAY FROM PERIMETER OF HOME IN ALL DIRECTIONS
8. INSTALL GROUND ANCHORS ACCORDING TO CURRENT RESIDENTIAL CODE OF NEWYORK STATE AND HOME
MANUFACTURER RECOMMENDATIONS
9. INSTALL SKIRTING AND VENTS ACCORDING TO HOME MANUFACTURER RECOMMENDATIONS
QUEENSBURY VILLAGE PIER FOUNDATIONS
ESSEx Mobile Home Park
Engineering Science& Tax Map No. 121-6-59 SCALE:As shown
Subsurface Exploratio4P.C. Petrie Lane PROJECT 05-13 FIGURE
Queensbury NY 12804 PREPARED BY:JLW07/08/05
1120 Vaughn Road,Hudson Falls,New York,12839 , CHECKED BY:PBA 07/08/057108/05
Jun, 29, 2023 .10;48AM No. 1381 P. 1
Cutler 8& Cutlerlaw, PLLc
2 Hemphill Place,Suite 153
Malta, New York 12020
Phone: (518) 849-9661//tax: (518) 899-6992
Debbie A, Cutler, Esq. Daryl S. Cudcr, Esq.
debbJeC&II(ler.1al•4 darvlc@cwIerItw
June 29,2023
Via Fax: (518).7454437
Craig Brown,Zoning Adminiatrator
Town of Queensbury Planning Office
742 Bay Road
Queensbury,NY 12804
Re: Queensbury Village Mobile Home Park
Dear Mr. Brown:
Please be advised that our office has been retained to represent Samuel J. Wahnon,Viola J.
Wahnon and Queensbury Village Mobile Home Park regarding addressing the"buffer".
Thank you for your attention to this matter.
Very truly yours,
CUTLER&CUTLER LAW,PLLC
Dary�S. der,Esq.
DSC:hey
INSTALL NO. 33040 STATE OF NEW YORK
DEPARTMENT OF STATE
ONE COMMERCE PLAZA
_ 99 WASHINGTON AVENUE
i ALBANY,NY 12231
INSTALLER'S WARRANTY SEAL
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE
NEW MANUFACTURED(HUD CODE) ❑ RELOCATED MANUFACTURED(HUD CODE)
A. Manufacturer's name:
Q��,!�
B. HUD label number: Serial number: A Joy.y. /? 14"p
C. Retailer's name:
D. Retailer's address: /. '�i� -»% /'1SU+ 't ��' -Z-S 3%
E. Retailer's certification M Telephone#:
F. Installer's name: %1 1111'L.)6-,e S r.�� l f� �.f �;+P'+3� G% 1C',' �,4.1.�C L G
G Installer's address:
H. Installer's certification M Telephone M
I. Date installation completed: 9l z5/i 3 Municipality issuing building permit:
(City,Town,Village)
J. Customer name and physical address(911)where home is installed: P/_1
.L fl 1/ .a 0 Pr-,%At . te. d7vf o&tis_/-L1'1ZY �'./f / T.�l� NewYork
By attaching this SEAL to this manufactured home,the undersigned Installer of this manufactured home warrants as follows:
1. That the installation of this manufactured home meets the standards of the New York State Uniform Fire Prevention and Building
Code.
2. That the Installer is certified as an installer by the New York State Department of State.
The foregoing warranties are in addition to and not in derogation of all other rights and privileges which the consumer may have under any.
other law or instrument.The foregoing warranties are in addition to,and not in limitation of or substitution for,any and ail other
warranties,express or implied,given or made by the Installer,whether contractually or by operation of law.
Printed Name of Person Signing Seal:
Signature of Installer or
Limited Installer:
If you have a problem with your home,you should first contact your installer or retailer.If the problem is not resolved by the Installer or
Retailer you can contact the Department of State at(518)474-4073.
DOS-1680(Rev.06/18)
Yellow Copy—Department of State White Copy—Retain for Your Records Goldenrod Copy—Permitting Agency Seal—Affix to Home