2010-528 .4411ft TOWN OFQ UEENSBURY
too742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100528 Date Issued: Wednesday, November 23, 2011
This is to certify that work requested to be done as shown by Permit Number P20100528
has been completed.
Tax Map Number: 523400-303-020-0001-010-000-0000
Location: 11 HIGHLAND Ave
Owner: TERRY& KATHLEEN MARCANTONIO
Applicant: TERRY& KATHLEEN MARCANTONIO
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 `+ /
property owner of the responsibility for compliance with Site Plan, f air
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
IT*AT 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100528 Application Number: A20100528
Tax Map No: 523400-303-020-0001-010-000-0000
Permission is hereby granted to: TERRY&KATHLEEN MARCANTONIO
For property located at 11 HIGHLAND 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: TERRY&KATHLEEN MARCANTO
90 MCDONALD St Test Pit/Perc Test Review
GLENS FALLS,NY 12801-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2010-528
deep hole/perc test
$0.00 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 T n o ueen9 ryAye(*Way,e�,day,November 23, 2011
SIGNED BY f for the Town of Queensbury.
✓J
Director of Building&Code Enforcement
_
( )
,� f • E
Town of Queensbury• Building&Codes Enforcement Office•742 Bay Roa ■ u eu u y-14--4d804--
DEEP HOLE/PERC TEST I
Request for Town Engineer Revi=w p. ... .. BURY s.•
Tr\V
cBt;.`_, )ES
Property Owner: i�rj f j� Phone: 5-)E 161 'SS2`I
Property Owner's
Address: 1 N--3‘,1‘,„,)Location of Test: 5t-rrvz Tax ID#:
*Applicant's Engineer: 7-06,-) n Phone: 7'/i C'3c6 7
Applicant's Agent: e-1)4 era,'" Mc tee_ Phone: _51J. S S2.q
Additional Notes: i-nnSTnvc.7-7', ,, - 26 x 2 orfNQ
1. Reason for Request? 7. New Septic System I Replacement Septic System Failed Septic System
Subdivision Site Plan Review
2.Are Wetlands present? YES X NO UNKNOWN
*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 plan, to scale, to be submitted with application
FEE SCHEDULE:
a. $200 Flat Fee Date Paid:
Check No.:
b. OR ee to be determined during To Be Determined:
' e Plan /Subdivision review process
SI NATURE:
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: 44 Date: ft/A'
SIGNATURE OF AGENT: !.- Date: /'1///!�
Original (B&C File) Canary(Planning) Pink(Applicant) Gold (Town Clerk)
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