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CC-000228-2016 TOWN OF QUEENSBURY QL742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 -- Community Development-Building&Codes (518)761-8256 CERTIFICATE OF OCCUPANCY Permit Number: CC-000228-2016 Date Issued: Monday, October 3, 2016 This is to certify that work requested to be done as shown by Permit Number CC-000228-2016 has been completed. Tax Map Number: 309.13-2-31.2 Location: 161 CAREY RD Owner: HHHN Applicant: Richard E.Jones Architects This structure may be occupied as a: Commercial Alt./Add.2110 s.f. Site Plan Approval for this portion of project was approved by the Planning By Order of Town Board Board; Site Plan Review No. 52-2014 August 19,2014 TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the r 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- CC-000228-20 16 Tax Map No: 309.13-2-31.2 Permission is hereby granted to: Rozell Industries Inc. For property located at: 161 CAREY RD In the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other inforunation hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance Type of Construction Owner Name: HHHN Factory-Industrial-Addition $476,800.00 Owner Address: 9 CAREY RD Total Value $476,800.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Rozell Industries Inc. 129 Park RD Queensbury,NY 12804 Plans&Specifications Commercial Alt./Add. 2110 s,f, Site Plan Approval for this portion of project was approved by the Planning,Board, Site Plan Review No.52-201.4 August 19,2014 $ 485.30 PERMIT FEE PAID -'THIS PERMIT EXPIRES: Friday,April 28, 2017 (Ifa 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 Town Queen ury; Wrh4at-28, 20'6 SINNED BY: for the'Town of Queensbury. Director of Building&Code Enforcement Office Use 111v Date:: Tax Map ID Pei-111it Fee C> Zone Historic? Yes X No Rec Fee Site Plan 9 4 P)A1.1i qjjJ q0c, L Subdivision Narrie 2- Subdivision Project Location 310 TOWN BD. RESOLUTION 86-2013: $850 recreation fee for new dwelling units single family,duplexes/two-fancily, 1-nultip1le- family, apartments,condominiums,townhouses,and/or manufactured! &modular homes, but not mobile homes. This is in addition to the permit feels). Prinlary owner(s) Address Phone/Ernail 0 Z'4 6-?2 ,tr, 0 Applicant V Address o/4<11or') )'Low 15110ff� Phone/Einail jJ� Contractor Address Phone/Email C Pontact Person f-br Building & Codes Coinpliance. P,6)jAtz r.) hone TYPE OF CONSTRUCTION VCheck all that apply New Addition Alteration I fl li Af.......... sf Height Single Family AN 'I'wo-Family "L S Multi-Farnily 44 (9 of units Townhouse Business Office Y/ Retail -Mercantile Factory-Industrial Attached Garage (1, 2, 3, 4+) Other Town of Queensbury Building&Codes Principal Structure Application revised January 2015 If commercial or industrial please indicate name of business V f lG 6,49-f-- Proposed use of building or addition G a G Source of Heat(circle one) Gas Oil Pr6pe Solar Other Fireplace: Complete a separate application for Fuel Burning A Appliances & Chimneys 1'� Are there structures not shown on plot plan? d Are there easements on the property? Site Information: a. Dimensions or acreage of lot A&x,I-6 b. Is this a corner lot? Yes No c. Will the grade be changed as a result of construction Yes No d. Public water or Private well(circle one) ubli Private e. Sewer or Private Septic System(circle one) Sewer Private Value of all work to be performed(labor or materials) $ DECLARATION.- 1. ECLARATION.1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period. J2. 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: 1 PRINT NAME: Z JODATE: © ' Z,pCLo SIGNATURE: DATE: 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 January 2016 SEPTIC DISPOSAL APPLICATION Office Use Only Received DATE: ©�-l°p -Z'4�21 Lo Tax Map ID TAx MAP ID: 120 , Z - 1 Permit No. ZONE: Permit Fee Gc.� APPLICANT j A (,� PHONE/E-MAIL ADDRESS 33q L)I'A''10', V-a-4w 1,��5 V jZ- 2;6029-- 1" aove INSTALLER/ f V ), �J S T Pt'F! )J(1 PHONE/E-MAIL BUILDER ? 17(k lL ii� V2_0, Q t)ad4�J Lr� Z�3 4' �✓ G�-��Q llrl / /�r LLQ OWNER tjbNi*v rti J -- u161L�L. ADDRESS 61 p, Z' pG�--- CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: yPICIk kW ��L7CJfi ?+L � PHONE/E-MAIL �U- RESIDENCE INFORMATION Year Built #of bedrooms X gallons per bedroom =total Daily flow 1980 or older Garbage grinder installed Yes No 1981-1991 Spa or Hot Tub installed Yes No 1992-Present PARCEL INFORMATION Topography _Fiat rolling Steep slope %Slope Soil Nature _Sand Loam Clay Other Groundwater At what depth: 24 Bedrock/Impervious material At what depth: Domestic Water Supply _Municipal Well(if well,water supply from any septic system absorption is_ft.) Percolation Test Rate: r_� per minute per inch(test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION Tank size t6,W gallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub System Absorption field with#2 stone Total length ft.;Each Trench Seepage Pit with#3 stone How many: ;Size Alternative System Bed or other type: L ` 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 known by or on behalf of an applicant,shall be void. I have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: t" DATE: P' S —) S - SIGNATURE: DATE: Town of Queensbury Building&C es Principal Structure Application Revised January 2016