Loading...
2007-672 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 . 4z Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20070672 Date Issued: Monday, December 08, 2008 This is to certify that work requested to be done as shown by Permit Number P20070672 has been completed. Tax Map Number. 523400-226-016-0001-017-000-0000 Location: 43 MASON Rd Owner: MARK & PAMELA KELLY Applicant: MARY & KATHERINE ABBOTT 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 � �,✓j property owner of the responsibility for compliance with Site Plan, VVV 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 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20070672 Application Number. A20070672 Tax Map No: 523400-226-016-0001-017-000-0000 Permission is hereby granted to: MARY &KATHERINE ABBOTT For property located at: 43 MASON 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 Value Owner Address: MARK&PAMELA KELLY 55 WEST Rd Test Pit/Perc Test Review EASTON, CT 06612-0000 Total value Contractor or Builders Name/Address Electrical Inspection Agency Plans &Specifications 2007-672 DEEP HOLE/PERC TEST $200.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,December 08, 2009 (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 tr: of77) ry; onday, December 08, 2008 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement rage i of i Dave Hatin To: Daniel W. Ryan, P.E. Cc: Pam Whiting Subject: Request for Town Engineer Review DEEP HOLE/PERC TEST Request for Town Engineer Review Name: Mark Kelly Phone: 203 255-1861 Address: 55 West Rd Easton, CT 06612 Location of Test: 43 Mason Rd Applicant's Engineer: Dennis MacElroy Phone: 761-0317 Applicant's Agent: Dennis MacElroy Phone: 761-0317 Additional Notes: Reason for Request: = New System Replacement System Failed System Are WETLANDS present? = YES NO UNKNOWN David Hatin Town of Queensbury Director of Buildings&Codes 761-8253 11/5/2007 0�- 05— Town of Queensbury• Building&Codes Enforcement Office•742 Bay Road- Queensbury,NY 12804 DEEP HOLE/PERC TEST Request for Town Engineer Review Property Owner: MARS F Vl.-- 1 Phone: -SKL-Z? Property Owner's Address: Location of Test: Aron->►3 #'' - � �4r4 Tax ID#: _-;;k'a4(a„►(© 17 *Applicant's Engineer:t.ita► r Phone: 776wl,-- Applicant's Agent: �E�ra\� A �1—V=4 Phone: Additional Notes: 1. Reason for Request? New Septic System Replacement Septic System Failed Septic System Subdivision ❑ Site Plan Review 2.Are Wetlands present? YES NO UNKNOWN *Note: Applicant is required to enaage an engineer for design and testing of the system. The Town Engineer's responsibility is to witness system testing only. PLOT PLAN: Plot plan, to scale, to be submitted with application FE HED a. $ 200 Fla Fee Date Paid: O- _07 Check No.: b. OR Fee to be determined during To Be Determined: Site Plan /Subdivision review process SIGNATURE: In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may engage the services of a qualified professional consultant for expert review and recommendation arising from the carrying out of the provisions of Art. IV, including but not limited to the review of plans, specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep hole and percolation tests, system installations, and any other aspect of any matter contained in this Art. IV, and any costs 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 of an invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to the party to be charged with same. My signature below indicates I have thoroughly read and understand the instructions, agree to the submission requirements and have completed the application. I also fully understand that additional engineering fees may be necessary per Town of Queensbury Local Law 136-14D. SIGNATURE OF APPLICANT: Date: SIGNATURE OF AGENT: Date: 1Q-Z(L-,7 Original (B &C File) Canary (Planning) Pink (Applicant) Gold (Town Clerk) Signature Page This page includes the 1.)Authorization to Act as Agent Form: 2.) Engineering Fee Disclosure; 3.)Authorization for Site Visits; 4.) Other Permit Responsibilities; 5.) Official Meeting Disclosure and 6.) Agreement to provide documentation required. OWNER's AGENT FORM: Complete the following if the OWNER of the property is not the same as the applicant Owner: Designates: As agent regarding: Variance Site Plan Subdivision For Tax Map No..: Section Block Lot Deed Reference: Book Page Date OWNER SIGNATURE: DATE: . APPLICANT'S AGENT FORM: Complete the following if the APPLICANT is unable to attend the meeting or wishes to be represented by another party: aw Owner: 1. � ikL Designates: `?v%v� �5 y «L As agent regarding: Variance Site Plan +- Subdivisions PTA For Tax Map No.: Section Block 11 Lot Deed Reference-—, Book Page Date 1, OWNER SIGNATURE: J '1 DATE: 2.1 ENGINEERING FEE DISCLOSURE: Applications may a referred to the Town consulting engineer for review of septic design,storm drainage,etc.as determined by the Zoning or Planning Department. Fees for engineering review services will be charged directly to the applicant. Fees for engineering review will not exceed$1,000 without notification to the applicant.. 3.) AUTHORIZATION FOR SITE VISITS: By signing this page and submitting the application materials attached herein, the Owner,Applicant, and his/her/their agent(s)hereby authorize the Zoning Board or Planning Board and Town Staff to enter the subject properties for the purpose of reviewing the application submitted. 4.) OTHER PERMIT RESPONSIBILITIES: Other permits may be required for construction or alteration activity subsequent to approval by the Zoning Board or Planning Board It is the applicant's responsibility to obtain any additional permits. 5.) OFFICIAL MEETING MINUTES DISCLOSURE: It is the practice of the Community Development Department to have a designated stenographer tape record the proceedings of meetings resuiting from application, and minutes transcribed from those tapes constitutes the official record of all proceedings. If there is a discrepancy such record and the handwritten minutes taken by the designated stenographer,the handwritten minutes shall be deemed the official record. 6.) AGREEMENT TO PROVIDE DOCUMENTATION REQUIRED: I, the undersigned, have thoroughly read and understand the instructions for submission and agree to the submission requirements, I acknowledge no construction activities shall be commenced prior to issuance of a valid permit. I certify that the application, plans and supporting materials are a true and complete statement/description of the existing conditions and the work proposed, and that all work will be performed in accordance with the approved plans and in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents, will obtain a certificate of occupancy as necessary.. 1 also understand that I/we may be 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. SIGNATURE OF APPLICANT: M1 DATE: SIGNATURE OF AGENT: 0 DATE: Town of Queensbury Planning Office- 742 Bay Road• Queensbury,NY 12804 518-761-8220 9 A, v l c. xv. wm or r we-am , r, A. 3 li E g. , �9 9 .i 9 , A x 4 o Y ,t EMS � AY we. ANY Y IiIP yi�ya: � y ; t 1 c"� t rat Ca � e SC ^y � �'� ;'i� � P ',-des (kE:LL--Y) opt : 3 CA-F-11.J1032Jr T ��V-A O'F Qur--E-A6 � . € l r � time sh,