RC-000513-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-000513-2016 Date Issued: Wednesday, June 7, 2017
This is to certify that work requested to be done as shown by Permit Number RC-000513-2016
has been completed.
Tax Map Number: 239.17-1-5
Location: 15 ANTIGUA RD
Owner: Daniel Pickett,I❑
Applicant: Bonacio Construction, Inc.
This structure may be occupied as a:Residential Alteration to basement
1,594 sq.ft. By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000513-2016
Tax Map No: 239.17-1-5
Permission is hereby granted to: Bonacio Construction,Inc.
For property located at: 15 ANTIGUA 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
Building Codes and the Queensbury Zoning Ordinance
Type of Construction
Owner Name: Daniel Pickett,III Single Family-Alteration $100,000.00
Owner Address: 589 N Broadway Total Value $100,000.00
Saratoga Springs,NY 12866
Contractor or Builders Name/Address Electrical Inspection Agency
Bonacio Construction,Inc.
18 Division ST,401
Saratoga Springs,NY 12866
Plans&Specifications
Residential Alteration to basement
1,594 sq.ft.
$239.10 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,September 28,2017
(If a longer period is required,an application for an exteriorimust be made to the code Enforcement Officer
of the Town of Quee efore the ire n4
.)
Dated at the Town Quee ( September 28,2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Onlv
Received
Date: 8lcZlllP. Tax Map ID o`Z2,9/7-/ -5
Permit No. C: Jr -D-0/
Tax Map ID Permit Fee
Zone /A0.6(\e Res,Cknce Rec Fee 05
Historic Site _Yes X No Site Plan#
Subdivision Name Lot# Subdivision#
Project Location \S Zc-�8
AUG 0 4 2015
TOWN BD. RESOLUTION 86-2013: $850 recreation fee for new dwelling units—single family,duplexes/two-family,
multiple family,apartments,condominiums,townhouses,and/or manufactured&modular homes, but not mobile
homes. This is in addition to the permit fee(s).
Applicant V'\nCe. Loi Ick ,, Owner Do, ;e\ r)-CVee-V-'
Address �g p J�S,on S�. Sv `1v\ Address 90c\ 14 ' ?Coa3cJc.
S�cq a S \r\c\& r1Y lau SaCrNo 5ti S t:n s nIY laaeb
Phone/E-mail Phone/E-mail S \g - 3(-S -0
ice@\-,�o,\o.C,o.CoM A dam, :c�e�� Q n�co�'rc�ct,ce, ccs
Contact Person for Building&Codes Compliance: Ask VgKA�gC Phone S\%-3o\-1775
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration 3"Boor sf 2"'floor s Total sf Height
6o�Seme�
Single Family
X \S9H w \S�y �
Two-Family
Multi-Family
(#of units_)
Townhouse
Business Office
Retail-Mercantile
Factory-Industrial
Attached Garage
(1, 2, 3, 4+)
Other
If commercial or industrial please indicate of business
Town of Queensbury Building&Codes Principal Structure Application Revised September 2015
i Proposed use of building or addition
Source of Heat(circle one) Gas i Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances &Chimneys N 1 A
Are there structures not shown on plot plan? N C)
Are there easements on the property? No
Site Information
a. Dimensions or acreage of lot \S d gya,q Sq f o 3,`1 b aCCeS
b. Is this a corner lot? No
c. Will the grade be changed as a result of construction _ Yes No
d. Public water or Private well
e. Sewer or Private Septic System V64q'}e,
Value of all work to be performed (labor or materials) $ \0a,o0c,
DECLARATION.•
1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period.
2. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and
department approval.
3. I certify that the application,plans and supporting materials are a true and complete statement/description of
the work proposed,that all work will be performed in accordance with the NYS Building Codes,local building
laws and ordinances, and in conformance with local zoning regulations
4. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy.
5. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: y �nC� e�°� DATE:
SIGNATURE: "vDATE:
For office use only
Operating Permit Issued: _Yes —No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
Town of Queensbury Building&Codes Principal Structure Application Revised September 2015
SEPTIC DISPOSAL PERMIT Office Use Only
DATE A'Aa.. V5 7A l Co Received
Tax Map ID
Tax MAP ID —'39-1-7- Permit No.
Permit Fee
LOCA TION OF INSTALLA TION 15 Aycnc,.v.A 3�b. Approvals:
APPLICANT 1 )C41-L4CKEI—E PHONE/E-MAIL
ADDRESS I✓ AtrnaA,i R&DLAKE GEAe.a'E 1 hlY \ZSo`ls
INSTALLER/BUILDER: 4-01><EQ.1+1\7'-ikE1 PHONE/E-MAIL
ADDRESS:
OPH I I S E D
Address ` '
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: V I r1GE. ��EQIZA PHONE 3TCn—32SZ
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed Y %N
1981-1991 Spa or Hot Tub installed !Y _N
1992-Present a 1
PARCEL INFORMATION
Topography Flat rolling _Steep slope —%slope
Soil Nature Sand --V-<oam Clay Other
Groundwater At what depth? 7 "�
Bedrock/Impervious Material At what depth? >9Z
Domestic Water Supply Municipal �(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: 7—per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size Z`,,c0gallons(minimum size 1,000 gallons, add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length ft.;Each trench x
Seepage Pit with#3 stone How many: ;size
Alternative System Bed or other type? E7 3EtV C0,5 F — :XDL-F L t CAL
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2) We will no longer
allow systems to be covered until such time as an As-Built plan is received & approved. The installed system must match the septic system
layout on file—no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations
and agree to a ida by these and all requirements of the Tovyn of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: wLr��(,►�� i'^Y 5E /,�,afcltl- Fkm Date: ALg,�.2i✓ ��
Signature: �r4�FcQ�_'?-aY �N Date:
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
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0 . I . I I � I I . I L � . . 1.. - . . I I Map of a Survey made for
"UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY
MAP BEARING A Ll"-SED LAND SURVEYORS SEAL IS A
Ln IL Dus VIOLATION OF SECTION 7209,SUB-DIMSON Z OF THE
NEW YORK STATE EDUCATION LAW."
F-1 &
U'l 'ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY
CA C_ MARKED VATH AN ORIGINAL OF TOE LAND SURVEYORS
SM SHALL BE CONSIDERED TD BE VALID TRUE COPIES,' & Jennif er 'Pickett
'CERTIFICATIONS INDICATED HEREON SIGNIFY THAT Danie
0 THIS SURVEY WAS PREPARED IN ACCORDANCE WTH THE
ATION OF PROFESSIONAL
EXISTING CODE OF PRACTICE FOR LAND SURVEYORS ADOPTED
BY THE NEw YORK STATE ASSOCI
LAND SURVEYOFM SAID CERTIFICATIONS SHALL RUN ONLY
VEY IS PREPARED,AND
�O Laiad S irveyors To THE PERSON FOR VMOM THE SUR Town of Queensbury, Warren ew.
ON HIS SE34ALF 70 THE TITLE COMPANY,COVERNMENTAL
AGENCY AND LENDING INS71TUITION USTED HEREON.AM
0
Queensbury,, New York TO THE ASS&GNEES OF THE LENDING INV7U n orge, Warren County, New York NO. DA TE
169 Haviland 'Road DESCRIPTION
New York Lic. No. 50135
—8474
(518) 792 '5
239.17-1-