2008-455 i
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development -Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20080455 Date Issued: Wednesday, November 23, 2011
This is to certify that work requested to be done as shown by Permit Number P20080455
has been completed.
Tax Map Number: 523400-252-000-0001-070-000-0000
Location: Alexy Ln
Owner: ALAN J GOLDSTEIN
Applicant: ALAN J GOLDSTEIN
This structure may be occupied as a:
Test Pit/Perc Test Review
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the � 1
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,Queensbuty,NY 12804-5902 {518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080455 Application Number: A20080455
Tax Map No: 523400-252-000-0001-070-000-0000
Permission is hereby granted to: ALAN J GOLDSTEIN
For property located at: Alexy 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: ALAN J GOLDSTEIN Test Pit/Perc Test Review
1754 CENTERAL Ave Total value
ALBANY,NY 12205-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2008-455
DEEP HOLE/PERC TEST
$200.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 23,2012
(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 To eensb j Vye&pday,November 23,2011
SIGNED BY s .' '�"`� for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Quoe"obnry^ Building&Codes Enforcement Office^74%Bay Roxd^ Qorenobury,NYl28V4
DEEP HOLE/PERC TEST
Request for Town Engineer Review
Property Owner: Phone: 7 g�ViC—N
Property Owner's
Address:
Location Lmcmtmnwf Test: Tax U0#:
*Applicant's Engineer: - Phone:
�
Applicant's Agent: Phone:
AdWkUwmm| Nptws:
1. R���rR��� �� New Septic System [] Replacement Septic System El Failed Septic System
[]
L_� 8ubdiviu|un LiJSite Plan Review
2.Are Wetlands present? � YES �{� [�� UNKNOWNF� ��
^
Note: Applicant is required to engage an engineer for design and testing of the system. The Town
Engineer's responsibility is to witness system testing only.
PLOT PLAN: Plot p|8O. to GCa|e, to be submitted with application
FEE SCHEDULE:
a. $ 200 Flat Fee Date Paid:
Check No.: 1220
b. OR Fee to be determined during To Be Determined:
Site Plan/Subdivision review process
In carrying out the provisions of Article |V. the Local Board of Health or the enforcement officer may
engage the services of o qualified professional consultant for expert review and recommendation arising
from the carrying out of the provisions of Art. |V, including but not limited to the review of p|mno,
specifications and repodo, attendance at inopecUono, dye teota, deep hole test pito, septic related damp
hole and percolation booto, system inataUaUono, and any other aspect of any matter contained in this Art.
|V, and any omnbo incurred in such review shall be paid to the Town by the owner of the property before
any approval can be granted under this Art. IV shall become effective within 30 days of presentment ofon
invoice for ooma, whichever is sooner. Such 000by shall not exceed $1.600 without prior written notice to
the party hobm charged with same.
My signature below indicates | have thoroughly read and understand the instru(tions, agree to the
submission requirements and have completed the application. | also fully VDdenSt8Dd that additional
engineering fees may be necessary per Town OfClUeensbury LOo8| L@vv 138-14C).
SIGNATURE OF APPL| ..-Date: 1�-~—
SIGNATURE OFAGENT: Date:
Original (B&C File) Caniary (Planning) Pink (Applicant) Gold (Town Clerk)