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2004-182 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: P20040182 Date Issued: Wednesday, April 14, 2004 This:is-to.certify:that:work requested-to-be--done-as shown.by Permit Number P20040182 has been completed. Tax Map Number: 523400-303-020-0002-008-000-0000 Location: 11 BELLE Ave Owner: JEFFREY &KAY COOK Applicant: JEFFREY & KAY COOK This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040182 Application Number: A20040182 Tax Map No: 523400-303-020-0002-008-000-0000 Permission is hereby granted to: TF,FFRF,Y&KAY COOK For property located at: 11 BELLE Ave 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: JEFFREY&KAY COOK 11 BELLE Ave Septic Alteration Residential Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2004-182 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, April 14, 2005 (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 Tg o ueen ry;,4 y,April 14, 2004 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit=Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: :........................................................................................................ Office Use Location of installation: Q File Permit No. W q � (;� Tax Map No. i,Z-) c f Fee Paid ) T Owner's Name: C JG .............................................................. ..................................................r........... Address: 3 13 G 4, c_ 2. INSTALLER'S NAME �S LO C PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Daily Flow 1980 or older x ' 150 gallbdrm = C' 1980— 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes_ / no k Spa or Hot Tub Installed yes ./ no 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) ,Zj@,�aphy SeNature Ground Water Bedrock or Im ervious Material Do Water Su 1 CFlat �am at/wAat depth at w/hatteep,th municipal ling fV/4 feet ��!' ''`et Steep slope clay if well; water supply slope other from any septic-system depth: absorption is ft. other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: minute per inch 5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size of the septic tank and leach field for each Garbage Grinder,Spa -o-r Whirlpool Tub. Septic Tank: l —gallon(min. size 1,000 gal) Tile Field: each trench ft. Total System Length: ft. Seepage Pit(s): number of _ size of each: ft. by ft. Size f Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: length rind/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) For your protection,please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or circumstance known by or on behalf of an applicant, shall be void. I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Al %nature of responsible person Date ' '1'awit of (Imaellsbuiv St;wcrs :ttul 'ctiv; Disposal t:Itstt)lrr A1, p :idix C. n-I'l-8 )1U)'' ION r`I FNA.) ' SI�:I'/1•ltn.'1'iW1`V Itl;tZl,3iltl�l�]I►�f�1'I`:i fpQNA My. .Try`• ` '• 1 .fir/ ..•.....� �,�� 1,11c, 51� `r;A .� y., WXAPIK%t PAW* Ro&n ............................ 7. Sj(NATURE &INFORMATION M USPU t S10",��r<�•,;'' oxen.....,...:; R Framing / Firestopping Inspection Report Office No. (518)761-8256 Date Inspection reque t rec i ed: Queensbury Building&Code Enforcement Arrive: am/p part" an 742 Bay Road, Queensbury,NY 12804 Inspector's Initials: —� NAME: P LAC PERMIT#: pt— LOCATION: �`�,— �, ��,`T INSPECT ON: TYPE OF STRUCTURE: Framing Y N N/A COMMENTS • Jack Studs/Headers Bracing/Bridging Joist hangers Jack Posts/Main Beams Exterior sheeting nailed properly 12"O.C. Headroom 6 ft. 8 in. Stairwells 36 in. or more Headroom 6 ft. 8 in. Notches/Holes/Bearing-Walls Metal Strapping for Notches Top Plate 1 %2(w) 16 gauge (8) 16D nails each side ��y�`�' Draft stopping 1,000 sq. ft, floor trusses `\ ^�` Anchor Bolts 6 ft. or less on center �. Ice and snow shield 24 inches from wall Fire separation 1, 2, 3 hour Fire wall 2, 3,4 hour Firestopping Penetration sealed 16 inch insulation in cavity min. Garage Fire Separation House side '/Z inch or 5/8 inch Type X Garage side 5/8 inch Type X Ceiling/wall Windows Habitable Space/Bedrooms 24 in. (H) 20 in. (W) 5.7 sf above/below grade 5.0 sf grade L:\SueHemingway\Building.Codes.Inspection.FORMS\Framing Firestopping Inspection Report.doc January 28,2003 Septic Inspection Report Office No. (518) 761-8256 Date Inspection reaerceQueensbury Building&Code Enforcement Arrive: at: ' . arn/742 Bay Rd., Queensbuiy,NY 12804 Inspector's InitialsNAME: r PELOCATION: c�.,y�Cr ��--�' IN RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x F1 Stone Size: `- Piping Size Type Building to tank Tank to Distribution Box 1 t D Distribution Box to Field/Pit Opening Sealed: Y/N/Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits A. Conforms as per Plot Plan Y N Location of System on Property: Front Rear Left Side Right Side , 1 fiddle Rear System Use Status: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: ' Queensbury Building&Code Enforcement Arrive: am3kie5 part: a am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: 0L'L' PERMIT NO.: LOCATION: INSPECT ON: c RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water jD Waterline separation distance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number _ Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/N/Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Location of System on Property: Front Rear L t Side Right Side Middle Fro Middle Rear System Use St s• Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingwayU3uilding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/ m epart: i am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: _ NAME: �� % PERMIT NO.: 0 _ LOCATION: 1\ INSPECT ON: RECHECK: Comments and/or diagram Soil Type(Sa / ay Type of Water: unici Well Water Waterline separatlon distance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench Z "ft.jl Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distributi Box Distribution Box dNeld/Pit °� K Opening Sealed: Y/ /Partial Location/Separations Foundation to tank Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan N Location of DRear on Property: Fron Left Side Right Side Mid Middle Rear S stem Use Status-proved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LASueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 i � `