2011-030 L �'` TOWN OFQ UEENSBURY
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742 BayRoad,Queensbury, -
NY 12804 5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number. P20110030 Date Issued: Monday, February 28, 2011
This is to certify that work requested to be done as shown by Permit Number P20110030
has been completed.
Location: PETRIE Ln
Tax Map Number. 523400-308-006-0001-061-000-0000
Owner. SAMUEL & VIOLA WAHNON
Applicant: SAMUEL & VIOLA WAHNON
This structure may be occupied as a:
Mobile Home In Park By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the Grv..., /) f // L--_Pro erty owner of the res onsibili 3for com liance with Site Plan, c1
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enfo°reement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110030 Application Number. A20110030
Tax Map No: 523400-308-006-0001-061-000-0000
Permission is hereby granted to: SAMUEL&VIOLA WAHNON
For property located at: PETRIE Ln
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: SAMUEL&VIOLA WAHNON
39 SARATOGA ROAD Mobile Home In Park $35,000.00
GANSEVOORT,NY 12831 Total Value $35,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2011-030
Elaine Brady- 18 Petrie Ln- 924 sq ft mobile home
$110.88 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, February 22,2012
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Tuesday,.Eebruary 22, 2011
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
-, jui
aY4 _ I /(�` OFFICE USE ONLY -- I i
, TAX MAP NO. /PERMIT NO. /f 030 DATE ISSUED:
• f=EL 08 2011 s
PERMIT FEE / •
• ik,�% APPROVALS: ZONING TOWN CLERK ; _- '/
NSBURY
MOBILE HOME —APPLICATION FOR PERMIT:
A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a
valid building permit has been issued.
•
Applicant Information Property Owner Information
� pp Lf
Name: ' Name: v14 7/69-4706
Address: >+ ,.(: a T�O L� (2
(t Address: _.3
EA. , , , . I t,,.; ,y--,
r 1 4 0 • ° 10.A.Z'
Phone No. Phone No. "7q,n__S/6
Parcel Information
n
Proposed Date of Placement: (�Q- Property Location: ( YLIA_.
Road,Street,Avenue
Name of Mobile Home Park: r:- U-CSAJA-11 L .a 1 /_ -7S-9
(dapplicableJ Tax Map Number: ��—
Mobile Home Information Zoning Information
Approximate Value of Home:$ 3S O c) Zoning Classification:
New Home: 0 NoG 4 ' Size of Property: ,`7,ft. by l 2S.
Replacement Home: Yes No . . Existing buildings:
Size of Mobile Home: 1/4 ft. by 6 (.17 ft. Setbacks: front yard 23-- ft. rear yard(> ft.
sideyards 2C) ft. and 21) ft.
Singlewide: T Doublewide: -
Number of Rooms: (exclude baths) Accessory Building(s): circle
Number of Bedrooms: 2.--
Number of Bathrooms: / Detached garage: 1-car 2-car car
Circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1-car 2-car car
Foundation Support: Storage building: Yes No
ape Size & Depth Other:
ers
Runners Water Supply: well or municipal
Slab Is Septic Permit Required? Yes or No
Continued on back
Town of Queensbury • Community Development Office • 742 Bay Road, Queensnury, iv r tzou'
Name of Installer or Mobile Home Dealer: 9g-0-44-- iT-d4.._ aeig ` 14in1A-0 .___-
Address: labq Oq Phone: 74? 2Z I
Complete information below found on a Plate"or'Sticker'which is affixed to the mobile home:
• Insignia serial number. 1 7-2--'0 qr?g 4-i-1
.✓ Name of manufacturer.
fE24 _-
/ Plan Approval Number F s l()3 2-0�r—to
✓ Model or Component Designation: 12-2'`00 C) — ii-—0 li 7S'E74-
(New home only)
✓ Date of Manufacture: 2____- ) 3— 0
.ssr r r.s....—r r..... sr r.. .sr-ar rrsr r r r r rrraarsrirses.......... ssruuuar:a rs1
AFFIDAVIT'
1
Town of Queensbury State of New York
County of Warren 1 ...
• N
N
i I swear that to the best of my knowledge and belief the 1
i statements contained in this application, together with the plans 8
and specifications submitted, are a true and complete statement
i of all proposed work to be done on the described premises and LI
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 1
5 work is authorized by the • i a -r. . g
r
Signature: ,` A. A�
Owner,Owner's'gent,Architect, Contractor
•w i
SPECIAL CONDITIONS OF PERMIT
w
By // '
•de En • r-ment Officer
Town of Queensbury• Community Develo y enf Office• 742 B, 'oad, Queensbury, NY 12804
INSTALL NO. 13522 STATE OF NEW YORK
DEPARTMENT OF STATE it
0 �v
ONE COMMERCE PLAZA
f Ir 99 WASHINGTON AVENUE
ALBANY,NY 12231
INSTALLER'S WARRANTY SEAL
THIS SEAL REMAINS THE PROPERTY OF THE DEPARTMENT OF STATE
NEW MANUFACTURED(HUD CODE) 0 RELOCATED MANUFACTURED(HUD CODE)
A. Manufacturer's name: cLA.e,", 40 r-,:e
B. HUD label number: P F a 3 2 45S-(0 Serial number: 122-C40 O_ _ /17R 74
C. Retailer's name:(. /eel S /J /Ina i e c J od,.,k7X'
� -lft
D. Retailer's address: /_/ `T
ge" � fr► _sr✓'G,o/4- /2. ' I
E. Retailer's certification#:-TE' 7 2 )37-2
Telephone#: / e - 79 _ 2 801
F. Installer's name: . y-1 ``
Q Installer's address: I () f'�; ,At. �e �O �.Z;h.� + ,t_)j t Z '
H. Installer's certification#: I j T 00 a-'7,a Telephone#: `� ?- U`� (Ste
I. Date installed: Pe b✓✓ 3 2o) Municipality issuing building permit: )PPn ��...)�`4
I --� 1 (City,Town, Villag
J. Customer name and physical address (911)where home is installed: Gt h.i I Q . t..-Ci.-
s i 8 04 ,New York.
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 all other warran-
ties,express or implied,given or made by the Installer,whether contractually or by operation of law.
Printed Name of Person Signing Seal: .:,' n r 1 �
Signature of Installer or J
Limited Installer: !r
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.03/09)
Yellow Copy—Department of State White Copy—Retain for Your Records Goldenrod Copy—Permitting Agency Seal—Affix to Home
2- 14 /11e$ i . �o,�,��
Queensbury Building & Code Enforcement— Manufact , ed / Modular Final Inspection
Office No. (518)761-8256 Arrive: am/p Depart .`1\am/pm
Date Inspection request received:, Inspector's Initials: .�
f/
NAME: l4 PERMIT#:
LOCATION: /8'
f r/ /—/\ ) DATE: 2 23 --//
Manufactured Home
Modular Home
Footings_ Foundation_ Backfill— Framing—
Comments:
yitsj No WA
Foundation support,pier spacing, /
Per manufacturer
Anchoring per manufacturer 2'from ends
Water line shut off
Sewer line support @ 4 feet
Heating Crossover[doublewide}off grd.
Dryer vented outside
Skirting ventilated 1 so.ft.tier 1,500 sq.ft.
Hot water relief valve piping outside V
Deck,porches,steps,railing
Furnace/hot water operating
Garage Fire proofing "\.//
Fire Door!Door losers
Plumbing Fixture/3"Vent through roof[Modular]
Foundation insulation[if applicable]
Smoke/Carbon Monoxide Detectors/Interconnected
Final Electrical V
Variance required ✓
Data Plate okay
Manufactured HUD seal okay
N./i/
Warranty Seal after January 1,2006
,1771
Installers Warranty Seal
18"x 24"access or 22'x 30"attic access
Vapor retarder under home 6 mil poly or other
911 Street number
Okay to issue C/C or CIO[Temp./Perm.]
Model# n � Serial# I f2.:2 -(�5� -�"�C ��>
Manufacturer \7 j)/"1�+' c.. 1 U ;C,1"WK%
Date of Manufacturer Z k 3\c21
L:1Pam Whiting120101Building Codes Forms\Manufactured_Modular Final Inspection 03 0410.doc